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NPI Code Detail

MEDICARE: DR. DANIEL G KELLEY

MEDICARE: DR. DANIEL G KELLEY
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
1103TH0100XHealth Service Psychologist20041889AIN
2103TC0700XClinical Psychologist071004574IL

General Provider Information

NPI Number : 1912038357
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DANIEL G KELLEY
Provider Business Mailing Address
First Line : 924 W 75TH ST STE 120-308
Second Line :
City : NAPERVILLE
State : IL
Zip : 60565-6193
Country : US
Telephone Number : 630-904-5200
Fax Number :
Provider Business Practice Location Address
First Line : 151 N MICHIGAN AVE
Second Line : STE 1718
City : CHICAGO
State : IL
Zip : 60601-7539
Country : US
Telephone Number : 312-565-1111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2007
Last Update Date : 07/07/2025

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