Provider Demographics
NPI:1356305882
Name:KELLY, KEVIN V (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:V
Last Name:KELLY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1256 WATERFORD DRIVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504
Mailing Address - Country:US
Mailing Address - Phone:630-499-2404
Mailing Address - Fax:630-499-2399
Practice Address - Street 1:2040 OGDEN AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-7206
Practice Address - Country:US
Practice Address - Phone:630-978-6770
Practice Address - Fax:630-978-6773
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2017-07-10
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Provider Licenses
StateLicense IDTaxonomies
IL036129046207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200036820AMedicaid
OK200036820AMedicaid
OK248510821Medicare PIN
$$$$$$$$$003OtherBC/BS
OK200036820AMedicaid