Provider Demographics
NPI:1265230171
Name:KELSEY, PAUL JR (BA)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:KELSEY
Suffix:JR
Gender:
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 KROTIAK RD
Mailing Address - Street 2:
Mailing Address - City:PARK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60466-1729
Mailing Address - Country:US
Mailing Address - Phone:708-248-4143
Mailing Address - Fax:708-283-0223
Practice Address - Street 1:15010 S RAVINIA AVE STE 12
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-5353
Practice Address - Country:US
Practice Address - Phone:708-971-0470
Practice Address - Fax:708-590-6573
Is Sole Proprietor?:No
Enumeration Date:2025-03-05
Last Update Date:2025-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program