Individual
DR. KELLY PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
036.143099
IL
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
036143099
IL
Other
Enumeration date
07/01/2010
Last updated
10/29/2025
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