Healthcare Provider Details

I. General information

NPI: 1881878221
Provider Name (Legal Business Name): NORTHWEST PULMONARY AND SLEEP MEDICINE SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2007
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 RYAN PKWY
ALGONQUIN IL
60102-4527
US

IV. Provider business mailing address

1340 RYAN PKWY
ALGONQUIN IL
60102-4527
US

V. Phone/Fax

Practice location:
  • Phone: 815-477-7350
  • Fax: 815-477-7351
Mailing address:
  • Phone: 815-477-7350
  • Fax: 815-477-7351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number036-104219
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier216086
Identifier TypeOTHER
Identifier State
Identifier IssuerPTAN

VIII. Authorized Official

Name: DR. DENNIS FRANKLIN KELLAR
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 815-477-7350