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NPI Code Detail

MEDICARE: KELLIE SLADKOV

MEDICARE: KELLIE SLADKOV
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
1367500000XCertified Registered Nurse Anesthetist209034172IL

General Provider Information

NPI Number : 1497615496
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLIE SLADKOV
Provider Business Mailing Address
First Line : 1558 WOODHAVEN ST
Second Line :
City : WHEATON
State : IL
Zip : 60189-7127
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5841 S MARYLAND AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60637-1443
Country : US
Telephone Number : 888-824-0200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2025
Last Update Date : 01/20/2026

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