Provider Demographics
NPI:1811975485
Name:STEVEN F KELSO DPM INC.
Entity type:Organization
Organization Name:STEVEN F KELSO DPM INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:FERRIS
Authorized Official - Last Name:KELSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-922-3668
Mailing Address - Street 1:500 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-6504
Mailing Address - Country:US
Mailing Address - Phone:916-922-3668
Mailing Address - Fax:916-922-3636
Practice Address - Street 1:500 UNIVERSITY AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6504
Practice Address - Country:US
Practice Address - Phone:916-922-3668
Practice Address - Fax:916-922-3636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2666213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAY53845Medicare UPIN
CAZZZ02284ZMedicare ID - Type Unspecified