Individual
KENNETH MARTIN LESTER KELLNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2650 RIDGE AVE STE 1505, EVANSTON, IL 60201-1718
(847) 570-2033
(847) 570-0231
Mailing address
2650 RIDGE AVE STE 1505, EVANSTON, IL 60201-1718
(847) 570-2033
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
036.148109
IL
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
036148109
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/25/2016
Last updated
04/07/2022
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