Michael J Kellum, MD
Individual provider Active NPI Emergency Medicine Physician · Whitewater, WI
NPI 1164599387 · NPPES record last updated Jul 24, 2015
Key facts
- NPI
- 1164599387
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- 36138-020 (WI)
- Practice address
- W9575 Homburg Lane
Whitewater, WI 53190 - Phone
- (262) 473-0961
- NPI assigned
- Nov 30, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36138-020 | WI | MD | Emergency Medical Services (Emergency Medicine) Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 36138-020 | WI | Yes |
| Emergency Medical Services (Emergency Medicine) Physician | 207PE0004X | 36138-020 | WI |
Addresses
Primary practice location
W9575 Homburg Lane
Whitewater, WI 53190
Mailing address
W9675 Homburg LN
Whitewater, WI 53190-3702
Phone (262) 473-0961
Other providers in Whitewater, WI
- Sydney A Joiner
- Linda Joyce Jones
- Thomas Michael Jones
- Kerry J Jung
- Abigail Marie Kabara
- Chad Kelsey
- Kenneth R Kidd
- Renee K. Kimball
- Kimberly S Knudsen
- Dannielle Koran
All providers in Whitewater, WI · Emergency Medicine Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 24, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.