MEDICARE: DR. DAVID P KELSEY MD

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	207Q00000X	Family Medicine Physician	4301054090	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275516734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID P KELSEY MD

Provider Business Mailing Address
First Line	:	5 W MADISON AVE
Second Line	:
City	:	NEW BUFFALO
State	:	MI
Zip	:	49117-1734
Country	:	US
Telephone Number	:	269-469-8484
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 W MADISON AVE
Second Line	:
City	:	NEW BUFFALO
State	:	MI
Zip	:	49117-1734
Country	:	US
Telephone Number	:	269-469-8484
Fax Number	:

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

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	05/13/2008

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