Provider Demographics
NPI:1073968418
Name:WOSS, KERRY (DO)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:WOSS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:
Other - Last Name:MATNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:99 PARK AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:CLARENDON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60514-1494
Mailing Address - Country:US
Mailing Address - Phone:630-455-7000
Mailing Address - Fax:
Practice Address - Street 1:99 PARK AVE STE 102
Practice Address - Street 2:
Practice Address - City:CLARENDON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60514-1494
Practice Address - Country:US
Practice Address - Phone:630-455-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-03
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036149704207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine