Provider Demographics
NPI:1407186034
Name:KEILSON AND ASSOCIATES MD PA
Entity Type:Organization
Organization Name:KEILSON AND ASSOCIATES MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:KEILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-257-5300
Mailing Address - Street 1:4110 WINGREN DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-3837
Mailing Address - Country:US
Mailing Address - Phone:972-257-5300
Mailing Address - Fax:972-257-5322
Practice Address - Street 1:3501 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 350
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-3651
Practice Address - Country:US
Practice Address - Phone:972-257-5300
Practice Address - Fax:972-257-5322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-04
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC3725207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty