Healthcare Provider Details

I. General information

NPI: 1245657782
Provider Name (Legal Business Name): KELLY JOY VALIGNOTA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2014
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 GREEN BAY ROAD
NORTH CHICAGO IL
60064
US

IV. Provider business mailing address

3001 GREEN BAY ROAD
NORTH CHICAGO IL
60064
US

V. Phone/Fax

Practice location:
  • Phone: 224-610-3745
  • Fax:
Mailing address:
  • Phone: 224-610-3745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number036146541
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number036146541
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: