Individual
MARK KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
25 N WINFIELD ROAD, WINFIELD, IL 60190
(630) 933-4240
Mailing address
89 OLD CREEK RD, PALOS PARK, IL 60464-1414
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
036091461
IL
Other
Enumeration date
12/05/2006
Last updated
07/09/2007
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