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Individual

DR. KELLY PARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
1200 SHERMER RD STE 200, NORTHBROOK, IL 60062-4563
(847) 559-0090
Mailing address
1800 AMBERLEY CT APT 112, LAKE FOREST, IL 60045-1057
(330) 247-8419
(877) 991-4957

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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