Individual
DR. LANCE KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2160 S 1ST AVE, MAYWOOD, IL 60153
(708) 216-9169
(708) 216-1249
Mailing address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(505) 220-5446
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036154058
IL
207L00000X
Anesthesiology Physician
125.072310
IL
Other
Enumeration date
03/29/2018
Last updated
06/26/2022
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