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General NPI Number Information
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NPI Number | 1952521981
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Entity Type | Individual
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Provider Name | CLAIRE KENNEALLY M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 11/14/2007
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Provider Practice Location Address
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Address Line | 530 WINNETKA AVE
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City | WINNETKA
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State | IL
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Zip | 60093-4023
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Country | US
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Telephone | 847-441-6868
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Fax |
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Provider Business Mailing Address
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Address Line | 530 WINNETKA AVE
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City | WINNETKA
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State | IL
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Zip | 60093-4023
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Country | US
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Telephone | 847-441-6868
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2004016468
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License Number State | MO
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