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NPI Code Detail

MEDICARE: RICHARD P KELLY DO

MEDICARE: RICHARD P KELLY DO
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
1207Q00000XFamily Medicine Physician036-099192IL

General Provider Information

NPI Number : 1831118264
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD P KELLY DO
Provider Business Mailing Address
First Line : 2357 SEQUOIA DR
Second Line :
City : AURORA
State : IL
Zip : 60506-6222
Country : US
Telephone Number : 630-859-6800
Fax Number :
Provider Business Practice Location Address
First Line : 80 TEMPLETON DR
Second Line :
City : OSWEGO
State : IL
Zip : 60543-7000
Country : US
Telephone Number : 630-554-3456
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2006
Last Update Date : 11/18/2021

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Directions to “ RICHARD P KELLY DO” Practice Location

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