Provider Demographics
NPI:1801885017
Name:KELSCH, TIMOTHY A (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:A
Last Name:KELSCH
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 1:3501 N SCOTTSDALE RD #160
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251
Mailing Address - Country:US
Mailing Address - Phone:480-273-8448
Mailing Address - Fax:480-273-8720
Practice Address - Street 1:3501 N SCOTTSDALE RD #160
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251
Practice Address - Country:US
Practice Address - Phone:480-273-8448
Practice Address - Fax:480-273-8720
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01055967A207Y00000X
AZ40325207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00734496OtherMEDICARE RR
204011284OtherBLUE CROSS
322201OtherHEALTHNET
AZ445001Medicaid