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NPI Code Detail

MEDICARE: ELAINE KELLY MD

MEDICARE: ELAINE KELLY 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
1207W00000XOphthalmology Physician125074492IL
2207W00000XOphthalmology Physician0191235AIN

General Provider Information

NPI Number : 1982264206
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELAINE KELLY MD
Provider Business Mailing Address
First Line : 1650 W HARRISON ST
Second Line :
City : CHICAGO
State : IL
Zip : 60612-3800
Country : US
Telephone Number : 312-942-5000
Fax Number :
Provider Business Practice Location Address
First Line : 6850 HOHMAN AVE
Second Line :
City : HAMMOND
State : IN
Zip : 46324-1410
Country : US
Telephone Number : 219-931-7509
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2019
Last Update Date : 03/06/2025

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Directions to “ ELAINE KELLY MD” Practice Location

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