Provider Demographics
NPI:1376620070
Name:HOBBS, KEIA KISHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:KEIA
Middle Name:KISHELLE
Last Name:HOBBS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KEIA
Other - Middle Name:KISHELLE
Other - Last Name:CLAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1919 W TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-7246
Mailing Address - Country:US
Mailing Address - Phone:312-996-2914
Mailing Address - Fax:
Practice Address - Street 1:1919 W TAYLOR ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7246
Practice Address - Country:US
Practice Address - Phone:312-996-2914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-01397207Q00000X
IL036-105930207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH74925Medicare UPIN