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NPI Code Detail

MEDICARE: TAYLOR KELLAM

MEDICARE: TAYLOR KELLAM
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
1363A00000XPhysician Assistant8441-23WI
2207P00000XEmergency Medicine Physician8441-23WI

General Provider Information

NPI Number : 1740965326
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAYLOR KELLAM
Provider Business Mailing Address
First Line : 835 S VAN BUREN ST
Second Line :
City : GREEN BAY
State : WI
Zip : 54301-3526
Country : US
Telephone Number : 920-433-0111
Fax Number :
Provider Business Practice Location Address
First Line : 835 S VAN BUREN ST
Second Line :
City : GREEN BAY
State : WI
Zip : 54301-3526
Country : US
Telephone Number : 920-433-0111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2023
Last Update Date : 01/15/2026

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Directions to “ TAYLOR KELLAM ” Practice Location

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