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NPI Code Detail

MEDICARE: DR. MICHAEL DONNELL KELSO JR. MD

MEDICARE: DR. MICHAEL DONNELL KELSO JR. 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
1207RG0100XGastroenterology PhysicianMD29794ME
2207RG0100XGastroenterology Physician201700853NC
3207RG0100XGastroenterology Physician1017371MA
4207RG0100XGastroenterology PhysicianMD.37611AL
5207RG0100XGastroenterology PhysicianC4462KY

General Provider Information

NPI Number : 1679868277
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL DONNELL KELSO JR. MD
Provider Business Mailing Address
First Line : 1215 7TH ST SE STE G200
Second Line :
City : DECATUR
State : AL
Zip : 35601-3387
Country : US
Telephone Number : 256-973-3225
Fax Number : 256-301-3860
Provider Business Practice Location Address
First Line : 1493 CAMBRIDGE ST
Second Line :
City : CAMBRIDGE
State : MA
Zip : 02139-1099
Country : US
Telephone Number : 617-665-1552
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2011
Last Update Date : 02/02/2026

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