Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kelly Pucillo, MD

Individual provider Family Medicine Physician · NPI 1548200595

Kelly Pucillo, MD is a Family Practice in Waupaca, Wisconsin. Graduated from Medical College of Wisconsin in 2005, 21 years ago. Practices with Thedacare, Incorporated, a 654-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Wisconsin.

Years since qualifying
21
Trained at
Medical College of Wisconsin
Licensed in
WI
In the registry since
2006
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

710 Riverside Dr
Waupaca, WI 54981-1941
Phone: (715) 258-1160
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 49596-020 (WI)

Record details

NPI number1548200595
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorNo
NPI enumeratedJune 7, 2006
Last updated in NPPESMarch 15, 2012
Mailing address710 Riverside Dr, Waupaca, WI 54981-1941

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolMEDICAL COLLEGE OF WISCONSIN
Graduated 2005 (21 years in practice)
Group practice Thedacare, Incorporated — 654 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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