MEDICARE: ANDREW H KELLUM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	10045	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427055185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW H KELLUM MD

Provider Business Mailing Address
First Line	:	961 SOUTH GLOSTER STREET
Second Line	:
City	:	TUPELO
State	:	MS
Zip	:	38801
Country	:	US
Telephone Number	:	662-844-9166
Fax Number	:

Provider Business Practice Location Address
First Line	:	961 SOUTH GLOSTER STREET
Second Line	:
City	:	TUPELO
State	:	MS
Zip	:	38801
Country	:	US
Telephone Number	:	662-844-9166
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	05/14/2010

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