Provider Demographics
NPI:1740274034
Name:KELINSKE, MARILYN A (MD)
Entity type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:A
Last Name:KELINSKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11623 ANGUS RD
Mailing Address - Street 2:STE 12
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4003
Mailing Address - Country:US
Mailing Address - Phone:512-346-2903
Mailing Address - Fax:512-346-2904
Practice Address - Street 1:11623 ANGUS RD
Practice Address - Street 2:STE 12
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4003
Practice Address - Country:US
Practice Address - Phone:512-346-2903
Practice Address - Fax:512-346-2904
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8615207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B23889Medicare UPIN
TX00PJ69Medicare ID - Type Unspecified