MEDICARE: KELSEY HARRISON PA

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1699541458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY HARRISON PA

Provider Business Mailing Address
First Line	:	32 CROSS CREEK BLVD
Second Line	:
City	:	ROCHESTER HLS
State	:	MI
Zip	:	48306-4303
Country	:	US
Telephone Number	:	248-928-6637
Fax Number	:

Provider Business Practice Location Address
First Line	:	32 CROSS CREEK BLVD
Second Line	:
City	:	ROCHESTER HLS
State	:	MI
Zip	:	48306-4303
Country	:	US
Telephone Number	:	248-928-6637
Fax Number	:

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

Provider Enumeration Date	:	12/01/2023
Last Update Date	:	12/01/2023

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Directions to “ KELSEY HARRISON PA” Practice Location

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