Healthcare Provider Details

I. General information

NPI: 1265451140
Provider Name (Legal Business Name): STEPHEN M KELANIC M.D., F.A.C.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 OGDEN AVE STE 401
AURORA IL
60504-7208
US

IV. Provider business mailing address

2040 OGDEN AVE STE 401
AURORA IL
60504-7208
US

V. Phone/Fax

Practice location:
  • Phone: 630-978-6895
  • Fax: 630-375-2905
Mailing address:
  • Phone: 630-978-6895
  • Fax: 630-375-2905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number036099831
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: