Individual
TANIA KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4440 W 95TH ST, OAK LAWN, IL 60453-2600
(708) 684-5341
(708) 684-4767
Mailing address
4440 W 95TH ST, OAK LAWN, IL 60453-2600
(708) 684-5341
(708) 684-4767
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036112183
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036112183
—
IL
Enumeration date
09/28/2006
Last updated
03/16/2011
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