Provider Demographics
NPI:1871026856
Name:ATASSI, KELLY MAE (DO)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MAE
Last Name:ATASSI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:MAE
Other - Last Name:BRANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:737 N MICHIGAN AVE STE 960
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-6659
Mailing Address - Country:US
Mailing Address - Phone:312-416-4363
Mailing Address - Fax:
Practice Address - Street 1:737 N MICHIGAN AVE STE 960
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-6659
Practice Address - Country:US
Practice Address - Phone:312-416-4363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.071616208100000X
IL0361570612081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation