Healthcare Provider Details

I. General information

NPI: 1235559659
Provider Name (Legal Business Name): KELSEY ELIZABETH GELHAUS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 11/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 FAIRVIEW BLVD
WYOMING MN
55092-8013
US

IV. Provider business mailing address

5200 FAIRVIEW BLVD
WYOMING MN
55092-8013
US

V. Phone/Fax

Practice location:
  • Phone: 651-982-7000
  • Fax:
Mailing address:
  • Phone: 651-982-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number63545
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: