Michael J Kellum, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

36138-020 Issued in WI

Practice address

W9575 Homburg Lane
Whitewater, WI 53190

Phone

(262) 473-0961

NPI assigned

Nov 30, 2006

Last updated

Jul 24, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437696000000",
    "number": "1164599387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W9675 HOMBURG LN",
            "city": "WHITEWATER",
            "state": "WI",
            "postal_code": "531903702",
            "telephone_number": "262-473-0961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W9575 HOMBURG LANE",
            "city": "WHITEWATER",
            "state": "WI",
            "postal_code": "53190",
            "telephone_number": "262-473-0961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLUM",
        "first_name": "MICHAEL",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-30",
        "last_updated": "2015-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WI",
            "license": "36138-020",
            "primary": true
        },
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "WI",
            "license": "36138-020",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sydney A Joiner
• Linda Joyce Jones, LPN
• Thomas Michael Jones, PT
• Kerry J Jung, LPC
• Abigail Marie Kabara, M.S., CCC-SLP
• Chad Kelsey, ATC
• Kenneth R Kidd, MD
• Renee K. Kimball, D.C.
• Kimberly S Knudsen, AU.D.
• Dannielle Koran, LAT

• Emergency Medicine Physician in Whitewater, WI
• Providers in Whitewater, WI by specialty
• Emergency Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.