Provider Demographics
NPI:1932106895
Name:KELSEY, EDWIN L (MD)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:L
Last Name:KELSEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 PRINCETON AVE SW
Mailing Address - Street 2:POB I SUITE 201
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35211-1310
Mailing Address - Country:US
Mailing Address - Phone:205-783-7705
Mailing Address - Fax:205-352-4433
Practice Address - Street 1:801 PRINCETON AVE SW
Practice Address - Street 2:POB I SUITE 201
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-1310
Practice Address - Country:US
Practice Address - Phone:205-783-7705
Practice Address - Fax:205-352-4433
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-06
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16871208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529914300Medicaid
AL1841352929OtherGROUP NPI
AL051511659Medicare PIN
AL1841352929OtherGROUP NPI