Individual
KELLY EUGENE TJELMELAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M D
Contact information
Practice address
4220 BULL CREEK RD, AUSTIN, TX 78731-6026
(512) 617-7500
Mailing address
4220 BULL CREEK RD, AUSTIN, TX 78731-6026
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
J7860
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110753404
—
TX
01
—
8AQ830
BCBS INDIVIDUAL NUMBER
TX
Enumeration date
10/03/2006
Last updated
05/22/2008
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