Healthcare Provider Details

I. General information

NPI: 1487843496
Provider Name (Legal Business Name): SAUGANASH HEALTH ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 AUSTIN ST STE 157
EVANSTON IL
60202-3452
US

IV. Provider business mailing address

800 AUSTIN ST STE 157
EVANSTON IL
60202-3452
US

V. Phone/Fax

Practice location:
  • Phone: 773-293-3510
  • Fax: 773-293-3514
Mailing address:
  • Phone: 773-293-3510
  • Fax: 773-293-3514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036063365
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036065656
License Number StateIL

VIII. Authorized Official

Name: DR. DEREK J KELLY
Title or Position: SENIOR PARTNER
Credential: MD
Phone: 773-293-3510