Individual
MAHARI KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
818 S WOLCOTT AVE STE 802, CHICAGO, IL 60612-3702
(312) 996-4656
Mailing address
2811 W 91ST ST, EVERGREEN PARK, IL 60805-1339
(773) 206-4466
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209018700
IL
Other
Enumeration date
01/28/2019
Last updated
01/28/2019
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