Provider Demographics
NPI:1184731457
Name:KELMAN, DONALD B (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:B
Last Name:KELMAN
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 1:1403 N BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-1321
Mailing Address - Country:US
Mailing Address - Phone:715-387-8782
Mailing Address - Fax:
Practice Address - Street 1:1403 N BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-1321
Practice Address - Country:US
Practice Address - Phone:715-387-8782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22421207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30292600Medicaid
WI30292600Medicaid