Provider Demographics
NPI:1164400743
Name:KELSO, STEVEN FERRIS (DPM)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:FERRIS
Last Name:KELSO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-6523
Mailing Address - Country:US
Mailing Address - Phone:916-922-3668
Mailing Address - Fax:916-920-1221
Practice Address - Street 1:500 UNIVERSITY AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6523
Practice Address - Country:US
Practice Address - Phone:916-922-3668
Practice Address - Fax:916-920-1221
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2666213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE2666OtherSTATE LICENSE
CA00E266610Medicare ID - Type UnspecifiedMEDICARE