Healthcare Provider Details

I. General information

NPI: 1306831730
Provider Name (Legal Business Name): DAVID C KELSALL MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 12/23/2020
Certification Date: 12/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E HAMPDEN AVE SUITE 430
ENGLEWOOD CO
80113-3781
US

IV. Provider business mailing address

601 E HAMPDEN AVE SUITE 430
ENGLEWOOD CO
80113-3781
US

V. Phone/Fax

Practice location:
  • Phone: 303-783-9220
  • Fax: 303-806-6292
Mailing address:
  • Phone: 303-783-9220
  • Fax: 303-806-6292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number28228
License Number StateCO

VIII. Authorized Official

Name: DAVID C KELSALL
Title or Position: MEDICAL DOCTOR
Credential: MD
Phone: 303-783-9220