Healthcare Provider Details

I. General information

NPI: 1053314740
Provider Name (Legal Business Name): ROBERT S KELSEY D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 05/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 DELHI ST STE 2200
DUBUQUE IA
52001-6358
US

IV. Provider business mailing address

1500 DELHI ST SUITE 2200
DUBUQUE IA
52001-6358
US

V. Phone/Fax

Practice location:
  • Phone: 563-557-5930
  • Fax: 563-557-5936
Mailing address:
  • Phone: 563-557-5930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number632
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: