MEDICARE: KELLI MARIE KILGORE D.O.

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	207V00000X	Obstetrics & Gynecology Physician	036.142936	IL

General Provider Information

NPI Number	:	1790120293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLI MARIE KILGORE D.O.

Provider Business Mailing Address
First Line	:	182 RIVER RD
Second Line	:
City	:	LAKE BARRINGTON
State	:	IL
Zip	:	60010-1169
Country	:	US
Telephone Number	:	515-770-9364
Fax Number	:

Provider Business Practice Location Address
First Line	:	22285 N PEPPER RD STE 111
Second Line	:
City	:	LAKE BARRINGTON
State	:	IL
Zip	:	60010-2539
Country	:	US
Telephone Number	:	847-382-7330
Fax Number	:

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

Provider Enumeration Date	:	05/09/2013
Last Update Date	:	01/03/2022

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