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General NPI Number Information
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NPI Number | 1629254750
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Entity Type | Individual
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Provider Name | MICHAEL JAMES KILKELLY M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/18/2008
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Last Update Date | 11/05/2014
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Provider Practice Location Address
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Address Line | 2233 W DIVISION ST DEPT OF EMERGENCY MEDICINE
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City | CHICAGO
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State | IL
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Zip | 60622-8151
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Country | US
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Telephone | 612-644-5230
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Fax |
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Provider Business Mailing Address
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Address Line | 600 N KINGSBURY ST APT 1411
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City | CHICAGO
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State | IL
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Zip | 60654-8114
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Country | US
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Telephone | 612-644-5230
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 4301090823
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 036.136153
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License Number State | IL
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