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General NPI Number Information
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NPI Number | 1619504842
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Entity Type | Individual
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Provider Name | MARCELLINE KEBU KEMMY MD
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Gender | Female
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Dates
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Enumeration Date | 03/26/2020
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Last Update Date | 09/25/2024
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Provider Practice Location Address
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Address Line | 835 S WOLCOTT AVE
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City | CHICAGO
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State | IL
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Zip | 60612-3748
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Country | US
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Telephone | 312-996-9858
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Fax |
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Provider Business Mailing Address
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Address Line | 820 S WOOD ST STE 100
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City | CHICAGO
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State | IL
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Zip | 60612-4325
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Country | US
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Telephone | 312-996-2933
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Fax |
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 0000000027
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 125.084763
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License Number State | IL
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