Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 01036784 | IN |
NPI | 1528433042 |
---|---|
Provider Name | Dr. Douglas Kenneth Kelsey |
First Address | Zionsville, IN 46077-9269 |
Second Address | Zionsville, IN 46077-9269 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2015 |
Last Update Date | 09/12/2015 |