Provider Demographics
NPI:1164862470
Name:CAMPBELL, KELLEE JANEEN (DPM)
Entity Type:Individual
Prefix:DR
First Name:KELLEE
Middle Name:JANEEN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2622 SW 81ST AVE
Mailing Address - Street 2:UNIT # 10-212
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-6706
Mailing Address - Country:US
Mailing Address - Phone:305-720-8493
Mailing Address - Fax:305-254-6331
Practice Address - Street 1:3020 NW 125TH AVE
Practice Address - Street 2:UNIT # 10-212
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-6317
Practice Address - Country:US
Practice Address - Phone:305-720-8493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-01
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPR343213ES0103X
FLPO3705213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery