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General NPI Number Information
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NPI Number | 1023569183
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Entity Type | Organization
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Legal Business Name | KELLY ABATE MD LLC
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Dates
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Enumeration Date | 10/24/2016
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Last Update Date | 11/12/2016
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Provider Practice Location Address
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Address Line | 1200 S YORK ST SUITE 3240
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City | ELMHURST
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State | IL
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Zip | 60126-5626
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Country | US
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Telephone | 630-758-8688
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Fax | 630-758-8687
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Provider Business Mailing Address
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Address Line | 1200 S YORK ST SUITE 3240
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City | ELMHURST
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State | IL
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Zip | 60126-5626
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Country | US
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Telephone | 630-758-8688
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Fax | 630-758-8687
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Authorized Official
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Title or Position | OWNER
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Name | KELLY ABATE
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Credential | MD
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Telephone | 630-758-8688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 036093183
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License Number State | IL
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