Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | 182660-1205 | UT |
NPI | 1841348240 |
---|---|
Provider Name | Dr. Steven Michael Kelly |
First Address | Layton, UT 84041-1140 |
Second Address | Bountiful, UT 84010-7667 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 03/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003084400 | (05) | ID |
110583300 | (05) | WY |
F89020 | (02) | UT |