| Kelseyville Family Practice | |
|
4135 Main St Kelseyville CA 95451-8941 | |
| (707) 279-2004 | |
| (707) 279-2832 |
| Full Name | Kelseyville Family Practice |
|---|---|
| Speciality | Family Medicine |
| Location | 4135 Main St, Kelseyville, California |
| Authorized Official Name and Position | Kirk G Andrus (OWNER) |
| Authorized Official Contact | 7072792204 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kelseyville Family Practice 4135 Main St Kelseyville CA 95451-8941 Ph: (707) 279-2204 | Kelseyville Family Practice 4135 Main St Kelseyville CA 95451-8941 Ph: (707) 279-2004 |
| NPI Number | 1700066529 |
|---|---|
| Provider Enumeration Date | 11/08/2007 |
| Last Update Date | 01/05/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700066529 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | G34543 (California) | Primary |
Adventist Health Clear Lake Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 5290 State St, Kelseyville, CA 95451 Phone: 707-279-8813 Fax: 707-279-2241 |