Provider Demographics
NPI:1457648347
Name:MAY, KELLY (DPM)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:MAY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:YENSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:9645 LINCOLNWAY LN
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-1866
Mailing Address - Country:US
Mailing Address - Phone:779-333-7419
Mailing Address - Fax:779-333-7460
Practice Address - Street 1:9645 LINCOLNWAY LN
Practice Address - Street 2:SUITE 104
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1866
Practice Address - Country:US
Practice Address - Phone:779-333-7419
Practice Address - Fax:779-333-7460
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005616213ES0103X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400154400Medicare PIN