Individual
MALLORY KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1113 DIXON ST, WASHINGTON, IL 61571-9004
(217) 502-2672
Mailing address
1113 DIXON ST, WASHINGTON, IL 61571-9004
(217) 502-2672
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
125.064460
IL
208000000X
Pediatrics Physician
125.064460
IL
Other
Enumeration date
06/23/2014
Last updated
06/23/2014
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