Healthcare Provider Details

I. General information

NPI: 1285897967
Provider Name (Legal Business Name): KAREN L GELLADA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 KYSOR DR
BYRON IL
61010-9402
US

IV. Provider business mailing address

130 KYSOR DR
BYRON IL
61010-9402
US

V. Phone/Fax

Practice location:
  • Phone: 309-672-4977
  • Fax:
Mailing address:
  • Phone: 815-971-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-127497
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number101961
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number101961
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number036-127497
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: