Healthcare Provider Details

I. General information

NPI: 1326218751
Provider Name (Legal Business Name): KALIN KELSO MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 12/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 PARK BEND DR STE 301
AUSTIN TX
78758-5387
US

IV. Provider business mailing address

2200 PARK BEND DR BLDG 1 STE 301
AUSTIN TX
78758-5387
US

V. Phone/Fax

Practice location:
  • Phone: 512-339-0440
  • Fax: 512-339-0454
Mailing address:
  • Phone: 512-339-0440
  • Fax: 512-339-0454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberJ4259
License Number StateTX

VIII. Authorized Official

Name: KALIN KELSO
Title or Position: PRESIDENT
Credential: MD
Phone: 512-339-0440