D Michael Kellam, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

4219A Issued in WY

Practice address

800 E 20TH St
Suite 110
Cheyenne, WY 82001-3859

Phone

(307) 634-7711

NPI assigned

Jun 16, 2006

Last updated

Jul 9, 2007By 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 3

Addresses

Other identifiers 4

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": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1982648937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 E 20TH ST",
            "address_2": "SUITE 110",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820013859",
            "telephone_number": "307-634-7711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 E 20TH ST",
            "address_2": "SUITE 110",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820013859",
            "telephone_number": "307-634-7711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLAM",
        "first_name": "D",
        "middle_name": "MICHAEL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-16",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WY",
            "license": "4219A",
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CO",
            "license": "26458",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NE",
            "license": "21264",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF WYOMING CRG",
            "identifier": "306010",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "91042192",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104015400",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF WYOMING MRI",
            "identifier": "303602",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Krysten Keck, MSW
• Sharon Keck
• Amanda C Keefe, P.T,
• Austin Keenan
• Janelle Kelch
• James F Keller, DDS
• Marilyn J. Keller
• Stephanie Lin Keller, CSW-099
• Evan Earle Kelley, MSPT, OCS
• Lauren L Kelly, PCSW

• Diagnostic Radiology Physician in Cheyenne, WY
• Providers in Cheyenne, WY by specialty
• Diagnostic Radiology Physician in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.