Individual
DR. DEREK JOSEPH KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
800 AUSTIN ST STE 157, EVANSTON, IL 60202-3452
(773) 293-3510
(773) 293-3514
Mailing address
800 AUSTIN ST STE 157, EVANSTON, IL 60202-3452
(773) 283-3510
(773) 293-3514
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036063365
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0031600421
BLUE CROSS
IL
Enumeration date
03/13/2007
Last updated
01/29/2026
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