Individual
MR. ERIC KELLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2215 17TH AVE, BROADVIEW, IL 60155-4728
(708) 344-7171
(708) 344-0319
Mailing address
2215 S 17TH AVE, BROADVIEW, IL 60155-4728
(708) 344-7171
(708) 344-0319
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
3657671
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03605761
—
IL
Enumeration date
11/22/2005
Last updated
02/10/2010
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