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NPI Code Detail

MEDICARE: KELLY NICOLE CORK M.D.

MEDICARE: KELLY NICOLE CORK 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
1207V00000XObstetrics & Gynecology Physician125054136IL

General Provider Information

NPI Number : 1831345651
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY NICOLE CORK M.D.
Provider Business Mailing Address
First Line : 1650 W HARRISON ST
Second Line : RUSH UNIVERSITY MEDICAL CENTER, DEPARTMENT OF OB-GYN
City : CHICAGO
State : IL
Zip : 60612-3800
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1650 W HARRISON ST
Second Line : RUSH UNIVERSITY MEDICAL CENTER, DEPARTMENT OF OB-GYN
City : CHICAGO
State : IL
Zip : 60612-3800
Country : US
Telephone Number : 312-942-6610
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2008
Last Update Date : 12/08/2021

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