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General NPI Number Information
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NPI Number | 1619193869
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Entity Type | Individual
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Provider Name | KELLY ANN WOOD M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 420 COLUMBIA CTR
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City | COLUMBIA
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State | IL
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Zip | 62236-2540
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Country | US
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Telephone | 618-791-2011
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Fax | 618-417-6046
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Provider Business Mailing Address
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Address Line | 420 COLUMBIA CTR
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City | COLUMBIA
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State | IL
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Zip | 62236-2540
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Country | US
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Telephone | 618-719-2011
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Fax | 618-417-6046
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 146940
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207QB0002X
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Taxonomy Name | Obesity Medicine (Family Medicine) Physician
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License Number | 89988457
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036123456
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License Number State | IL
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