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Individual

DYMPNA M KELLY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
5841 S MARYLAND AVE # MC5026, CHICAGO, IL 60637-1443
(773) 702-1061
Mailing address
150 HARVESTER DR STE 300, BURR RIDGE, IL 60527-5965
(773) 702-1061

Taxonomy

Speciality
Code
Description
License number
State
204F00000X
Transplant Surgery Physician
Primary
036142636
IL
208600000X
Surgery Physician
35086230
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2691207
OH
Enumeration date
08/30/2006
Last updated
02/06/2019
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