Individual
KELLY PERILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
303 W OGDEN AVE, WESTMONT, IL 60559-1419
(630) 967-2227
Mailing address
PO BOX 713260, CHICAGO, IL 60677-1260
(630) 469-9200
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085000763
IL
363AS0400X
Surgical Physician Assistant
085000763
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
085000763
—
IL
01
—
970003572
RAILROAD MEDICARE
IL
Enumeration date
09/27/2005
Last updated
07/25/2023
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