Provider Demographics
NPI:1841274693
Name:KELLNER, WILLIAM JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:KELLNER
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 1:555 REDBIRD CIR
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-7977
Mailing Address - Country:US
Mailing Address - Phone:920-338-6820
Mailing Address - Fax:
Practice Address - Street 1:555 REDBIRD CIR
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-7977
Practice Address - Country:US
Practice Address - Phone:920-338-6820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23105208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI23105OtherLICENSE
WI000068Medicare Oscar/Certification
WI073550055Medicare Oscar/Certification
WI23105OtherLICENSE
WI000012Medicare Oscar/Certification
WI000022Medicare Oscar/Certification
WID33576Medicare UPIN
000128Medicare Oscar/Certification