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General NPI Number Information
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NPI Number | 1144527409
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Entity Type | Organization
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Legal Business Name | DAVID DEMETRI KELNER
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Dates
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Enumeration Date | 02/23/2011
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Last Update Date | 02/23/2011
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Provider Practice Location Address
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Address Line | 938 W NELSON ST FIRST FLOOR
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City | CHICAGO
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State | IL
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Zip | 60657-6704
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Country | US
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Telephone | 773-883-0200
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Fax | 773-883-0090
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Provider Business Mailing Address
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Address Line | 938 W NELSON ST FIRST FLOOR
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City | CHICAGO
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State | IL
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Zip | 60657-6704
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Country | US
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Telephone | 773-883-0200
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Fax | 773-883-0090
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | DR. DAVID DEMETRI KELNER
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Credential | M.D.
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Telephone | 773-883-0200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036106847
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License Number State | IL
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