Individual
DR. JONATHAN RICHARD KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
600 SOUTH PAULINA STREET, CHICAGO, IL 60612
(312) 942-2832
(708) 579-3954
Mailing address
51 NORTH BRAINARD AVENUE, LAGRANGE, IL 60525-0575
(708) 482-0090
(708) 579-3954
Taxonomy
Speciality
Code
Description
License number
State
2084F0202X
Forensic Psychiatry Physician
Primary
036059014
IL
Other
Enumeration date
11/17/2010
Last updated
11/17/2010
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