Healthcare Provider Details

I. General information

NPI: 1053772962
Provider Name (Legal Business Name): ANNEMARIE FOX KELLY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2016
Last Update Date: 03/24/2020
Certification Date: 03/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE BOX 86
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

215 E CHESTNUT ST APT 1002
CHICAGO IL
60611-2359
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-3220
  • Fax:
Mailing address:
  • Phone: 913-302-8990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.149211
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: