| Kelada Physicians Group, Inc | |
|
680 Sunrise Ave Roseville CA 95661-4110 | |
| (916) 786-4700 | |
| (916) 786-3912 |
| Full Name | Kelada Physicians Group, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 680 Sunrise Ave, Roseville, California |
| Authorized Official Name and Position | John Paul Youssry Kelada (VICE PRESIDENT/SECRETARY) |
| Authorized Official Contact | 9167864700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kelada Physicians Group, Inc 680 Sunrise Ave Roseville CA 95661-4110 Ph: (916) 786-4700 | Kelada Physicians Group, Inc 680 Sunrise Ave Roseville CA 95661-4110 Ph: (916) 786-4700 |
| NPI Number | 1437707387 |
|---|---|
| Provider Enumeration Date | 09/03/2019 |
| Last Update Date | 09/03/2019 |
| Medicare PECOS PAC ID | 9638401144 |
|---|---|
| Medicare Enrollment ID | O20200121002257 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437707387 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Youssry Kelada |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316919442 PECOS PAC ID: 6608937511 Enrollment ID: I20090219000669 |
| Provider Name | John Paul Youssry Kelada |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013396118 PECOS PAC ID: 9830465822 Enrollment ID: I20171018002737 |
| Provider Name | Alexandra-mary Kelada |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1811429418 PECOS PAC ID: 5294006656 Enrollment ID: I20200710001703 |
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