Provider Demographics
NPI:1720272685
Name:CLAIRE KENNEALLY, LTD
Entity Type:Organization
Organization Name:CLAIRE KENNEALLY, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEALLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-441-6868
Mailing Address - Street 1:530 WINNETKA AVE
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-4023
Mailing Address - Country:US
Mailing Address - Phone:847-441-6868
Mailing Address - Fax:847-441-6895
Practice Address - Street 1:530 WINNETKA AVE
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093-4023
Practice Address - Country:US
Practice Address - Phone:847-441-6868
Practice Address - Fax:847-441-6895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL215611Medicare PIN