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1639604994

NPI Code Detail

MEDICARE: DR. THOMAS JAMES KELSEY M.D.

MEDICARE: DR. THOMAS JAMES KELSEY M.D.

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	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	01098457A	IN
2	207X00000X	Orthopaedic Surgery Physician	01098457A	IN
3	207X00000X	Orthopaedic Surgery Physician	30989	NE
4	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	036178836	IL
5	207X00000X	Orthopaedic Surgery Physician	036178836	IL

General Provider Information

NPI Number	:	1639604994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS JAMES KELSEY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 555191
Second Line	:
City	:	CAMP PENDLETON
State	:	CA
Zip	:	92055-5191
Country	:	US
Telephone Number	:	760-725-1288
Fax Number	:

Provider Business Practice Location Address
First Line	:	1611 W HARRISON ST STE 400
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-4861
Country	:	US
Telephone Number	:	877-632-6637
Fax Number	:	708-409-5179

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

Provider Enumeration Date	:	04/25/2017
Last Update Date	:	05/08/2026

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Directions to “ DR. THOMAS JAMES KELSEY M.D.” Practice Location

Language	Start Address	Practice Location

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