Provider Demographics
NPI:1871598748
Name:KELEKIAN, ARA (DPM)
Entity type:Individual
Prefix:DR
First Name:ARA
Middle Name:
Last Name:KELEKIAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 W BEVERLY BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-3665
Mailing Address - Country:US
Mailing Address - Phone:323-346-0996
Mailing Address - Fax:323-346-0986
Practice Address - Street 1:515 W BEVERLY BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-3665
Practice Address - Country:US
Practice Address - Phone:323-346-0996
Practice Address - Fax:323-346-0986
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4536213ES0103X, 213E00000X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19642Medicare ID - Type UnspecifiedCORPORATE GROUP NUMBER
CAP00698657Medicare PIN
CAU99622Medicare UPIN
CAWE4536BMedicare PIN
CA5649950001Medicare NSC
CA5189370001Medicare NSC
CA5649950002Medicare NSC