MEDICARE: DR. KATHLEEN KELLY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083X0100X	Occupational Medicine Physician	36079899	IL

General Provider Information

NPI Number	:	1346294667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHLEEN KELLY M.D.

Provider Business Mailing Address
First Line	:	801 S WASHINGTON ST
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60540-7430
Country	:	US
Telephone Number	:	630-355-0450
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 N WEBER RD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-1518
Country	:	US
Telephone Number	:	630-646-5770
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	10/04/2013

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