Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 036142636 | IL |
N | 208200000X | Surgeon | 35086230 | OH |
N | 208600000X | Surgeon | 35086230 | OH |
NPI | 1558471862 |
---|---|
Provider Name | Dympna M Kelly |
First Address | Burr Ridge, IL 60527-5965 |
Second Address | Chicago, IL 60637-1443 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 06/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2691207 | (05) | OH |
H11549 | (02) | OH |