Healthcare Provider Details

I. General information

NPI: 1477552677
Provider Name (Legal Business Name): THOMAS KIELY D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 N HALSTED ST SUITE 301
CHICAGO IL
60657-5188
US

IV. Provider business mailing address

3000 N HALSTED ST SUITE 301
CHICAGO IL
60657-5188
US

V. Phone/Fax

Practice location:
  • Phone: 773-296-7160
  • Fax: 773-296-3440
Mailing address:
  • Phone: 773-296-7160
  • Fax: 773-296-3440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number016003749
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: