Individual
KELLY CODERRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1500 S FAIRFIELD AVE, CHICAGO, IL 60608-1782
(773) 542-2000
Mailing address
820 BRUCE AVE, FLOSSMOOR, IL 60422-1250
(708) 612-6036
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085.006717
IL
Other
Enumeration date
12/17/2018
Last updated
12/17/2018
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