Basic Information
Provider Information
NPI: 1235559659
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GELHAUS
FirstName: KELSEY
MiddleName: ELIZABETH
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5200 FAIRVIEW BLVD
Address2:  
City: WYOMING
State: MN
PostalCode: 550928013
CountryCode: US
TelephoneNumber: 6519827000
FaxNumber:  
Practice Location
Address1: 5200 FAIRVIEW BLVD
Address2:  
City: WYOMING
State: MN
PostalCode: 550928013
CountryCode: US
TelephoneNumber: 6519827000
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/24/2014
LastUpdateDate: 11/25/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000X63545MNY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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