Individual
DR. KYLE BLAINE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, PHD
Contact information
Practice address
820 S WOOD ST # MC675, CHICAGO, IL 60612-4325
(312) 996-2933
Mailing address
820 S WOOD ST # MC675, CHICAGO, IL 60612-4325
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
125.081707
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/31/2023
Last updated
05/12/2023
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