Provider Demographics
NPI:1942615265
Name:KYLLO, RACHEL (MD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:KYLLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:BRADEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:676 N SAINT CLAIR ST STE 1600
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2997
Mailing Address - Country:US
Mailing Address - Phone:312-695-8106
Mailing Address - Fax:
Practice Address - Street 1:3783 VOGEL RD
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010
Practice Address - Country:US
Practice Address - Phone:636-751-0995
Practice Address - Fax:866-783-0115
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036146021207NS0135X
MO2019001305207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology