Provider Demographics
NPI:1902851181
Name:KELNER, DAVID D (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:D
Last Name:KELNER
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 1:7234 OGDEN AVE
Mailing Address - Street 2:SUITE 3N
Mailing Address - City:RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546-2269
Mailing Address - Country:US
Mailing Address - Phone:708-447-2277
Mailing Address - Fax:708-447-2274
Practice Address - Street 1:7234 OGDEN AVE
Practice Address - Street 2:SUITE 3N
Practice Address - City:RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546-2269
Practice Address - Country:US
Practice Address - Phone:708-447-2277
Practice Address - Fax:708-447-2274
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361068472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036106847Medicaid
ILK26979Medicare ID - Type Unspecified