Healthcare Provider Details

I. General information

NPI: 1144980053
Provider Name (Legal Business Name): KELSEY M MADEJ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2021
Last Update Date: 12/20/2021
Certification Date: 12/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 N RANDALL RD STE 210
ELGIN IL
60123-7879
US

IV. Provider business mailing address

1402 LONDON RD
NEW LENOX IL
60451-9740
US

V. Phone/Fax

Practice location:
  • Phone: 224-760-7322
  • Fax: 224-535-8252
Mailing address:
  • Phone: 815-462-4181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209024344
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: