Provider Demographics
NPI:1528580065
Name:DUGAN, KELLY (NP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:DUGAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 S WABASH AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2491
Mailing Address - Country:US
Mailing Address - Phone:312-842-4400
Mailing Address - Fax:312-842-4595
Practice Address - Street 1:2850 S WABASH AVE STE 106
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2491
Practice Address - Country:US
Practice Address - Phone:312-842-4400
Practice Address - Fax:312-842-4595
Is Sole Proprietor?:No
Enumeration Date:2017-07-15
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209015727363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner