Individual
DR. SCOTT W. KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12805 W BURLEIGH RD, SUITE 200, BROOKFIELD, WI 53005-3111
(262) 797-6434
(262) 797-6429
Mailing address
14275 MIDWAY RD, SUITE 400, ADDISON, TX 75001-3614
(214) 932-8029
(610) 271-4245
Taxonomy
Speciality
Code
Description
License number
State
207ZD0900X
Dermatopathology (Pathology) Physician
Primary
36968
WI
207ZP0101X
Anatomic Pathology Physician
36968
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0540955
—
IA
05
—
32649200
—
WI
Enumeration date
12/30/2005
Last updated
05/01/2015
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