Individual
DR. JAMES M KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
555 W COURT ST, SUITE 100, KANKAKEE, IL 60901-3664
(815) 932-7246
(815) 932-7307
Mailing address
555 W COURT ST, SUITE 100, KANKAKEE, IL 60901-3664
(815) 932-7246
(815) 932-7307
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036065101
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036065101
—
IL
01
—
050026565
RAILROAD MEDICARE
IL
Enumeration date
12/14/2005
Last updated
03/16/2020
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