Provider Demographics
NPI:1265451140
Name:KELANIC, STEPHEN M (MD, FACS)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:M
Last Name:KELANIC
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Gender:M
Credentials:MD, FACS
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2040 OGDEN AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-7208
Mailing Address - Country:US
Mailing Address - Phone:630-978-6895
Mailing Address - Fax:630-375-2905
Practice Address - Street 1:2040 OGDEN AVE STE 401
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-7208
Practice Address - Country:US
Practice Address - Phone:630-978-6895
Practice Address - Fax:630-375-2905
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036099831207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4506907OtherBLUE CROSS BLUE SHIELD
IL040017903OtherRAIL ROAD MEDICARE
ILH08942Medicaid
ILH08942Medicaid