Provider Demographics
NPI:1124020540
Name:KAMELLE, SCOTT A (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:KAMELLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 W. KINNICKINNIC RIVER PKWY
Mailing Address - Street 2:SUITE 525
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215
Mailing Address - Country:US
Mailing Address - Phone:414-385-2488
Mailing Address - Fax:414-385-2481
Practice Address - Street 1:2801 W. KINNICKINNIC RIVER PKWY
Practice Address - Street 2:SUITE 525
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215
Practice Address - Country:US
Practice Address - Phone:414-385-2488
Practice Address - Fax:414-385-2481
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT043496207VX0201X
WI50226207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34768200Medicaid
CTH13540Medicare UPIN
CT160002262Medicare ID - Type Unspecified
WIH13540Medicare UPIN