Individual
MICHAEL C KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D
Contact information
Practice address
5425 W LAKE ST, CHICAGO, IL 60644-2342
(773) 378-3347
Mailing address
568 S SPRING RD, STE A, ELMHURST, IL 60126-3868
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
19030568
IL
Other
Enumeration date
05/04/2016
Last updated
12/24/2019
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