Independent US Healthcare Provider Directory & Public Medical Database
Deactivated NPI 1255043089 Deactivated / Inactive NPI Male Practitioner

Wallace T Kellum

Driver • Chicago, IL

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Wallace Kellum has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date December 26, 2022
NPI Deactivation Date February 07, 2026
Total Practice Duration ~4 Years of Practice (2022 – 2026)

Professional Overview & Biography Verified Profile Summary

Wallace Kellum was a registered Driver practicing in Chicago, IL. Throughout an active medical career spanning 4 years, Wallace Kellum provided care at the practice location at 5949 S ABERDEEN ST until profile deactivation on 2026-02-07.

Practice Location & Contact Primary Location

Practice Address

5949 S Aberdeen St

Chicago, IL 606211429

Telephone 7735569732

Specialty Benchmarks & Practice Insights

Comparative analytics for Driver in Chicago, IL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 10.2 Yrs
Regional Practice Density
76 Specialists

Practicing in Chicago, IL (286 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Driver Primary Specialty

NUCC Taxonomy Code: 172A00000X

State License IL CG83801

A person employed to operate a motor vehicle as a carrier of persons or property.

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated February 07, 2026

Record deactivated on February 07, 2026

NPI Profile Active December 26, 2022

NPI status registered as active in NPPES database

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Updated Practice Location December 26, 2022

Registered at 5949 S ABERDEEN ST, CHICAGO, IL 606211429 (Tel: 7735569732)

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Updated Business Mailing Address December 26, 2022

Registered at 5949 S ABERDEEN ST, CHICAGO, IL 606211429 (Tel: 7735569732)

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Provider Name / Credentials Updated December 26, 2022

Recorded as WALLACE KELLUM

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Medical Taxonomy / Specialty Registered (Primary Specialty) December 26, 2022

Driver (License #CG83801 in IL)

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Initial NPI Registration & Enumeration December 26, 2022

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1255043089
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: December 26, 2022
Last Update: December 26, 2022
Deactivation Date: February 07, 2026

Mailing Address

5949 S Aberdeen St

Chicago, IL 606211429

Phone: 7735569732

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.