Provider Demographics
NPI:1932178001
Name:KELSO, KALIN D (MD)
Entity Type:Individual
Prefix:
First Name:KALIN
Middle Name:D
Last Name:KELSO
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 1:2200 PARK BEND DR BLDG 1
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5387
Mailing Address - Country:US
Mailing Address - Phone:512-339-0440
Mailing Address - Fax:512-339-0454
Practice Address - Street 1:2200 PARK BEND DR BLDG 1
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5387
Practice Address - Country:US
Practice Address - Phone:512-339-0440
Practice Address - Fax:512-339-0454
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4259207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096677203Medicaid
TX81684NMedicare PIN
TXG36847Medicare UPIN
TX200041766Medicare PIN