Healthcare Provider Details

I. General information

NPI: 1619116472
Provider Name (Legal Business Name): KELLY GORZ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2009
Last Update Date: 02/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

666 DUNDEE RD SUITE 307
NORTHBROOK IL
60062-2727
US

IV. Provider business mailing address

666 DUNDEE RD SUITE 307
NORTHBROOK IL
60062-2727
US

V. Phone/Fax

Practice location:
  • Phone: 312-339-7698
  • Fax:
Mailing address:
  • Phone: 312-339-7698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172P00000X
TaxonomyNaprapath
License Number181000345
License Number StateIL

VIII. Authorized Official

Name: DR. KELLY M GORZ
Title or Position: PRESIDENT
Credential: D.N.
Phone: 312-339-7698