Individual
MRS. KAY PONTIUS KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
25451 MENOMINI CT, WHEATON, IL 60189
(630) 254-5352
(630) 810-1037
Mailing address
25451 MENOMINI CT, WHEATON, IL 60189
(630) 254-5352
(630) 810-1037
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
036-056877
IL
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036-056877
—
IL
Enumeration date
07/21/2006
Last updated
09/22/2022
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