MEDICARE: KELLY DUGAN NP

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	363L00000X	Nurse Practitioner	209015727	IL

General Provider Information

NPI Number	:	1528580065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY DUGAN NP

Provider Business Mailing Address
First Line	:	2850 S WABASH AVE STE 106
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-2491
Country	:	US
Telephone Number	:	312-842-4400
Fax Number	:	312-842-4595

Provider Business Practice Location Address
First Line	:	2850 S WABASH AVE STE 106
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-2491
Country	:	US
Telephone Number	:	312-842-4400
Fax Number	:	312-842-4595

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

Provider Enumeration Date	:	07/15/2017
Last Update Date	:	07/21/2021

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Directions to “ KELLY DUGAN NP” Practice Location

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