Organization
KELSO NEUROMONITORING PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY K PUTTY MD (SOLE MEMBER)
(800) 310-7334
Entity
Organization
Contact information
Practice address
10981 N CAMINO DE OESTE, TUCSON, AZ 85742-9121
(800) 310-7334
Mailing address
DEPT # 880459 PO BOX 29650, PHOENIX, AZ 85038-9650
(800) 310-7334
Taxonomy
Speciality
Code
Description
License number
State
204R00000X
Electrodiagnostic Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20640
MEDICAL LICENSE
AZ
Enumeration date
02/08/2019
Last updated
08/10/2021
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