Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VX0201X | Gynecologic Oncologist | 043496 | CT |
Y | 207VX0201X | Gynecologic Oncologist | 50226 | WI |
NPI | 1124020540 |
---|---|
Provider Name | Scott A Kamelle |
First Address | Milwaukee, WI 53215 |
Second Address | Milwaukee, WI 53215 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2005 |
Last Update Date | 02/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H13540 | (02) | CT |
H13540 | (02) | WI |