Provider Demographics
NPI:1316214364
Name:SIDNEY A. KELT JR., M.D., P.A.
Entity type:Organization
Organization Name:SIDNEY A. KELT JR., M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:KELT
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:469-766-7046
Mailing Address - Street 1:3500 OAKLAWN AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4349
Mailing Address - Country:US
Mailing Address - Phone:972-709-1961
Mailing Address - Fax:
Practice Address - Street 1:3500 OAKLAWN AVE
Practice Address - Street 2:STE 300
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4349
Practice Address - Country:US
Practice Address - Phone:972-709-1961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-18
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH16012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113854702Medicaid
TX113854702Medicaid
TX00A32XMedicare PIN