MEDICARE: DR. LAURIANN THERESE KELLNER 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	208000000X	Pediatrics Physician	036-104052	IL

General Provider Information

NPI Number	:	1710105689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURIANN THERESE KELLNER M.D.

Provider Business Mailing Address
First Line	:	913 N MITCHELL AVE
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-5432
Country	:	US
Telephone Number	:	630-562-9142
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 S BROADWAY
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60505-4276
Country	:	US
Telephone Number	:	630-896-7900
Fax Number	:

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

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	07/08/2007

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