Provider Demographics
NPI:1215020573
Name:FRANK, KELLEY ANN (DPM)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:ANN
Last Name:FRANK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 871
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60006-0871
Mailing Address - Country:US
Mailing Address - Phone:847-956-1269
Mailing Address - Fax:
Practice Address - Street 1:800 BIESTERFIELD RD
Practice Address - Street 2:SUITE 406
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3361
Practice Address - Country:US
Practice Address - Phone:847-258-5524
Practice Address - Fax:847-979-8076
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004333213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL60001714OtherBC/BS NUMBER
ILP00000748OtherRR MEDICARE PIN
IL528900Medicare ID - Type UnspecifiedPROVIDER NUMBER
ILP00000748OtherRR MEDICARE PIN