Healthcare Provider Details

I. General information

NPI: 1275516734
Provider Name (Legal Business Name): DAVID P KELSEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 W MADISON AVE
NEW BUFFALO MI
49117-1734
US

IV. Provider business mailing address

5 W MADISON AVE
NEW BUFFALO MI
49117-1734
US

V. Phone/Fax

Practice location:
  • Phone: 269-469-8484
  • Fax:
Mailing address:
  • Phone: 269-469-8484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301054090
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: