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NPI Code Detail

MEDICARE: DR. CASEY KELLEY MD

MEDICARE: DR. CASEY KELLEY MD
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 Physician125053132IL

General Provider Information

NPI Number : 1942435573
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CASEY KELLEY MD
Provider Business Mailing Address
First Line : 1644 N PAULINA ST
Second Line :
City : CHICAGO
State : IL
Zip : 60622-1404
Country : US
Telephone Number : 773-675-1400
Fax Number : 773-598-6616
Provider Business Practice Location Address
First Line : 1732 W HUBBARD ST STE 2A
Second Line :
City : CHICAGO
State : IL
Zip : 60622-6271
Country : US
Telephone Number : 773-675-1400
Fax Number : 773-598-6616
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2009
Last Update Date : 10/17/2024

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Directions to “ DR. CASEY KELLEY MD” Practice Location

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