MEDICARE: STEVEN FERRIS KELSO DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	E2666	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	E2666	OTHER	CA	STATE LICENSE

General Provider Information

NPI Number	:	1164400743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN FERRIS KELSO DPM

Provider Business Mailing Address
First Line	:	500 UNIVERSITY AVE
Second Line	:	SUITE 200
City	:	SACRAMENTO
State	:	CA
Zip	:	95825-6523
Country	:	US
Telephone Number	:	916-922-3668
Fax Number	:	916-920-1221

Provider Business Practice Location Address
First Line	:	500 UNIVERSITY AVE
Second Line	:	SUITE 200
City	:	SACRAMENTO
State	:	CA
Zip	:	95825-6523
Country	:	US
Telephone Number	:	916-922-3668
Fax Number	:	916-920-1221

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	07/08/2007

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Directions to “ STEVEN FERRIS KELSO DPM” Practice Location

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