Organization
DR MARY KELLY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY KELLY (OWNER)
(708) 848-0040
Entity
Organization
Contact information
Practice address
7319 NORTH AVE, RIVER FOREST, IL 60305-1220
(708) 848-0040
Mailing address
7319 NORTH AVE, RIVER FOREST, IL 60305-1220
(708) 848-0040
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036077560
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036077560
—
IL
Enumeration date
06/23/2008
Last updated
06/23/2008
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