Healthcare Provider Details

I. General information

NPI: 1538784079
Provider Name (Legal Business Name): KELLY ELISE BLAIR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 W CENTRAL RD STE 7200
ARLINGTON HEIGHTS IL
60005-2382
US

IV. Provider business mailing address

2650 RIDGE AVE # 1223
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 847-618-4430
  • Fax: 847-618-0786
Mailing address:
  • Phone: 847-982-3175
  • Fax: 847-982-3394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036164728
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: