Individual
KELLY PAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
4500 MEMORIAL DR, BELLEVILLE, IL 62226-5360
(618) 233-7750
(618) 257-6860
Mailing address
2100 POWELL ST STE 920, EMERYVILLE, CA 94608-1844
(510) 350-2600
(510) 879-9100
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
385001464
IL
Other
Enumeration date
05/20/2008
Last updated
06/17/2013
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