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General NPI Number Information
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NPI Number | 1679868277
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Entity Type | Individual
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Provider Name | MICHAEL DONNELL KELSO JR. MD
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Gender | Male
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Dates
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Enumeration Date | 06/13/2011
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Last Update Date | 02/02/2026
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Provider Practice Location Address
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Address Line | 1493 CAMBRIDGE ST
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City | CAMBRIDGE
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State | MA
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Zip | 02139-1099
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Country | US
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Telephone | 617-665-1552
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Fax |
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Provider Business Mailing Address
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Address Line | 1215 7TH ST SE STE G200
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City | DECATUR
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State | AL
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Zip | 35601-3387
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Country | US
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Telephone | 256-973-3225
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Fax | 256-301-3860
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | MD29794
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 201700853
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 1017371
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | MD.37611
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License Number State | AL
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Taxonomy #5
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | C4462
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License Number State | KY
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