DR MARY KELLY NPI 1164683157

NPI Information

NPI: 1164683157
Provider Name: DR MARY KELLY
Classification: Family Medicine - 207Q00000X
Entity Type: Organization
Address:
7319 NORTH AVE
RIVER FOREST, IL
ZIP 60305
Phone: (708) 848-0040
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DR MARY KELLY is a family medicine in River Forest, IL. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. DR MARY KELLY NPI is 1164683157. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

7319 NORTH AVE
RIVER FOREST, IL
ZIP 60305-220
Phone: (708) 848-0040

The provider's authorized official is Mary Kelly .
The authorized official title is Owner and has the following contact phone number (708) 848-0040.

The enumeration date for this NPI number is 6/23/2008 and was last updated on 6/23/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207Q00000X	Family Medicine		036077560	ILLINOIS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	036077560	MEDICAID	ILLINOIS
2	D89609	MEDICARE UPIN	ILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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