MEDICARE: MRS. MARILYN A KELINSKE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	E8615	TX

General Provider Information

NPI Number	:	1740274034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARILYN A KELINSKE MD

Provider Business Mailing Address
First Line	:	11623 ANGUS RD
Second Line	:	STE 12
City	:	AUSTIN
State	:	TX
Zip	:	78759-4003
Country	:	US
Telephone Number	:	512-346-2903
Fax Number	:	512-346-2904

Provider Business Practice Location Address
First Line	:	11623 ANGUS RD
Second Line	:	STE 12
City	:	AUSTIN
State	:	TX
Zip	:	78759-4003
Country	:	US
Telephone Number	:	512-346-2903
Fax Number	:	512-346-2904

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	07/08/2007

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