Provider Demographics
NPI:1215945894
Name:ANGELL, KELSEY FAYE (MD MPAS)
Entity type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:FAYE
Last Name:ANGELL
Suffix:
Gender:F
Credentials:MD MPAS
Other - Prefix:MS
Other - First Name:KELSEY
Other - Middle Name:FAYE ANGELL
Other - Last Name:MCEWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1 VETERANS DR
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-2309
Mailing Address - Country:US
Mailing Address - Phone:612-467-1100
Mailing Address - Fax:
Practice Address - Street 1:1 VETERANS DR
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-2309
Practice Address - Country:US
Practice Address - Phone:612-467-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085003576363A00000X
WI1746-023363A00000X
MN67200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41989800Medicaid
FA9799985OtherDEA
WI41989800Medicaid
WI0040Medicare PIN