Healthcare Provider Details

I. General information

NPI: 1508480021
Provider Name (Legal Business Name): KELSEY MARIE BOHL MS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KELSEY MARIE OWENS

II. Dates (important events)

Enumeration Date: 06/01/2020
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9301 GOLF RD
DES PLAINES IL
60016-1667
US

IV. Provider business mailing address

2650 RIDGE AVE STE 1223
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 847-296-8151
  • Fax: 847-296-3915
Mailing address:
  • Phone: 847-570-2040
  • Fax: 847-570-5315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085011939
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601009939
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: