Provider Demographics
NPI:1144377052
Name:HUIATT, KELLY R (MD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:R
Last Name:HUIATT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7232 RUSH LIMA RD
Mailing Address - Street 2:
Mailing Address - City:HONEOYE FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14472-9002
Mailing Address - Country:US
Mailing Address - Phone:585-582-2732
Mailing Address - Fax:
Practice Address - Street 1:1425 PORTLAND AVE
Practice Address - Street 2:ROCHESTER GENERAL HOSPITAL ED
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3001
Practice Address - Country:US
Practice Address - Phone:585-922-3469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY203830207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC9885Medicare PIN