Provider Demographics
NPI:1124649322
Name:EATON, KELSEY JAMES (DO)
Entity type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:JAMES
Last Name:EATON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CHILDRENS HOSPITAL OF MICHIGAN 3901 BEAUBIEN
Mailing Address - Street 2:3RD FLOOR CARLS BLDG
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CHILDRENS HOSPITAL OF MICHIGAN 3901 BEAUBIEN
Practice Address - Street 2:3RD FLOOR CARLS BLDG
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-5402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-29
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program