Individual
MR. TELLY R SHELTON SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7810 S EUCLID AVE, 2S, CHICAGO, IL 60649-4626
(708) 502-3718
Mailing address
7810 S EUCLID AVE, 2S, CHICAGO, IL 60649
(708) 502-3718
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
S43581676353
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1811373418
MEDICAL PROVIDER
IL
Enumeration date
08/05/2015
Last updated
11/09/2015
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