Organization
ERIC KELLEY, M.D.,S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERIC KELLEY M.D. (PHYSICIAN)
(708) 344-7171
Entity
Organization
Contact information
Practice address
2215 SOUTH 17TH AVENUE, BROADVIEW, IL 60155-3908
(708) 344-7171
(708) 344-0319
Mailing address
2215 SOUTH 17TH AVENUE, BROADVIEW, IL 60155-3908
(708) 344-7171
(708) 344-0319
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036057671
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036057671
—
IL
Enumeration date
10/17/2011
Last updated
10/17/2011
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