Individual
DR. MICHAEL J KELLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
W9575 HOMBURG LANE, WHITEWATER, WI 53190
(262) 473-0961
Mailing address
W9675 HOMBURG LN, WHITEWATER, WI 53190-3702
(262) 473-0961
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
36138-020
WI
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
36138-020
WI
Other
Enumeration date
11/30/2006
Last updated
07/24/2015
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