Provider Demographics
NPI:1437188224
Name:KELLS, KENNETH GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:GEORGE
Last Name:KELLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-2425
Mailing Address - Country:US
Mailing Address - Phone:847-294-5490
Mailing Address - Fax:847-294-5496
Practice Address - Street 1:1255 MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-2425
Practice Address - Country:US
Practice Address - Phone:847-294-5490
Practice Address - Fax:847-294-5496
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILIL036084093207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine