Basic Information
Provider Information
NPI: 1982966735
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GALSTER
FirstName: KELLEN
MiddleName: T
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2040 W CHARLESTON BLVD STE 504
Address2:  
City: LAS VEGAS
State: NV
PostalCode: 891022207
CountryCode: US
TelephoneNumber: 7026716437
FaxNumber:  
Practice Location
Address1: 2040 W CHARLESTON BLVD STE 504
Address2:  
City: LAS VEGAS
State: NV
PostalCode: 891022207
CountryCode: US
TelephoneNumber: 7026716437
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/07/2012
LastUpdateDate: 12/17/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000XA135358CAY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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