Provider Demographics
NPI:1023569183
Name:KELLY ABATE MD LLC
Entity Type:Organization
Organization Name:KELLY ABATE MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ABATE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-758-8688
Mailing Address - Street 1:1200 S YORK ST
Mailing Address - Street 2:SUITE 3240
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5626
Mailing Address - Country:US
Mailing Address - Phone:630-758-8688
Mailing Address - Fax:630-758-8687
Practice Address - Street 1:1200 S YORK ST
Practice Address - Street 2:SUITE 3240
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5626
Practice Address - Country:US
Practice Address - Phone:630-758-8688
Practice Address - Fax:630-758-8687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-24
Last Update Date:2016-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036093183207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty