MEDICARE: DR. PATRICIA ANN KELLEHER 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	2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician	36-088048	IL
2	2083X0100X	Occupational Medicine Physician	036-088048	IL

General Provider Information

NPI Number	:	1871518191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA ANN KELLEHER M.D.

Provider Business Mailing Address
First Line	:	1901 W HARRISON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3714
Country	:	US
Telephone Number	:	312-864-4665
Fax Number	:

Provider Business Practice Location Address
First Line	:	2606 GRANT ST
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-2112
Country	:	US
Telephone Number	:	847-475-7041
Fax Number	:

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	08/10/2020

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