Provider Demographics
NPI:1871775759
Name:MARILYN A KELINSKE MD PA
Entity type:Organization
Organization Name:MARILYN A KELINSKE MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:KELINSKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-346-2903
Mailing Address - Street 1:11623 ANGUS ROAD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4041
Mailing Address - Country:US
Mailing Address - Phone:512-346-2903
Mailing Address - Fax:512-346-2904
Practice Address - Street 1:11623 ANGUS ROAD
Practice Address - Street 2:SUITE 12
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4041
Practice Address - Country:US
Practice Address - Phone:512-346-2903
Practice Address - Fax:512-346-2904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty