Individual
DR. ETHAN KELLUM
Active
Individual
DR. ETHAN KELLUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
35.129501
OH
207X00000X
Orthopaedic Surgery Physician
Primary
54782
TN
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
54782
TN
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
ME 123920
FL
Other
Enumeration date
06/26/2008
Last updated
03/21/2017
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