Provider Demographics
NPI:1710105689
Name:KELLNER, LAURIANN THERESE (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURIANN
Middle Name:THERESE
Last Name:KELLNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 N MITCHELL AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-5432
Mailing Address - Country:US
Mailing Address - Phone:630-562-9142
Mailing Address - Fax:
Practice Address - Street 1:101 S BROADWAY
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505-4276
Practice Address - Country:US
Practice Address - Phone:630-896-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-104052208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics