| Doctor Name: | DR. MICHAEL J KELLUM |
| NPI Number: | 1164599387 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 36138-020 |
| Business Practice Address: | W9575 Homburg Lane Whitewater, WI - 53190 |
| Business Phone Number: | 2624730961 |
| Business Fax Number: | |
| Mailing Address: | W9675 Homburg Ln, WHITEWATER |
| State: | WI |
| Postal Code: | 531903702 |
| Phone Number: | 2624730961 |
| Fax Number: | |
| NPI Enumeration Date: | 11/30/2006 |
| NPI Last Update Date: | 07/24/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207PE0004X |
| License Number: | 36138-020 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Emergency Medicine |
| Taxonomy Specialization: | Emergency Medical Services |
| Taxonomy Definition: | An emergency medicine physician who specializes in non-hospital based emergency medical services (e.g., disaster site, accident scene, transport vehicle, etc.) to provide pre-hospital assessment, treatment, and transport patients. |