MEDICARE: DAVID P. KELSEY, M.D. KELSEY MEDICAL CENTER

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	204F00000X	Transplant Surgery Physician		MI
2	207Q00000X	Family Medicine Physician		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	:	1952512311
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID P. KELSEY, M.D. KELSEY MEDICAL CENTER

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	:	OWNER
Name	:	DAVID P KELSEY
Credential	:	MD
Telephone Number	:	269-469-8484

Provider Enumeration Date	:	05/25/2007
Last Update Date	:	06/16/2008

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