Provider Demographics
NPI:1558881482
Name:SPELTIE, EDWARD MICHAEL (DO)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:MICHAEL
Last Name:SPELTIE
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 1:2251 W ROSECRANS AVE STE 18-21
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90222-3858
Mailing Address - Country:US
Mailing Address - Phone:424-529-6755
Mailing Address - Fax:
Practice Address - Street 1:2251 W ROSECRANS AVE STE 18-21
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90222-3858
Practice Address - Country:US
Practice Address - Phone:424-529-6755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A17447207R00000X, 207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program