Provider Demographics
NPI:1245283647
Name:KALLEN, RONALD J (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:J
Last Name:KALLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:353 LAKESIDE PL
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-5371
Mailing Address - Country:US
Mailing Address - Phone:847-433-3345
Mailing Address - Fax:847-433-4426
Practice Address - Street 1:2300 N CHILDRENS PLZ
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3363
Practice Address - Country:US
Practice Address - Phone:847-433-3345
Practice Address - Fax:847-433-4426
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2010-12-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036430262080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036043026Medicaid
IL036043026Medicaid
IL689361Medicare ID - Type Unspecified