MEDICARE: KELSEY GALLO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	036176988	IL
2	2088F0040X	Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician	036176988	IL

General Provider Information

NPI Number	:	1184117962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY GALLO MD

Provider Business Mailing Address
First Line	:	2650 RIDGE AVE # 1223
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-1700
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 CENTRAL ST STE 720
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-1779
Country	:	US
Telephone Number	:	847-503-3000
Fax Number	:	847-503-3500

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2018
Last Update Date	:	04/20/2026

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Directions to “ KELSEY GALLO MD” Practice Location

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