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NPI Code Detail

MEDICARE: KELSEY CACIC M.D.

MEDICARE: KELSEY CACIC 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
12084A2900XNeurocritical Care Physician35.139029OH
2208D00000XGeneral Practice Physician35.139029OH

General Provider Information

NPI Number : 1982068953
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELSEY CACIC M.D.
Provider Business Mailing Address
First Line : 3551 ROGER BROOKE DR
Second Line :
City : FORT SAM HOUSTON
State : TX
Zip : 78234-4504
Country : US
Telephone Number : 210-916-2203
Fax Number :
Provider Business Practice Location Address
First Line : 3551 ROGER BROOKE DR
Second Line : JBSA-FORT SAM HOUSTON
City : SAN ANTONIO
State : TX
Zip : 78234-4504
Country : US
Telephone Number : 210-292-5077
Fax Number : 210-292-7868
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2016
Last Update Date : 06/18/2026

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Directions to “ KELSEY CACIC M.D.” Practice Location

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