Organization
KELLAM & ASSOCIATES, P. C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH TARR (PRESIDENT)
(810) 667-5744
Entity
Organization
Contact information
Practice address
1375 N MAIN ST, LAPEER, MI 48446-1350
(810) 667-5500
Mailing address
PO BOX 32627, DETROIT, MI 48232-0627
(866) 744-1452
(586) 412-4101
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
—
—
261QR0200X
Radiology Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300F361250
BCBS GROUP #
MI
01
—
CA3518
RR GROUP PIN
MI
Enumeration date
07/05/2006
Last updated
02/06/2013
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