Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 016004333 | IL |
NPI | 1215020573 |
---|---|
Provider Name | Kelley Ann Frank |
First Address | Arlington Heights, IL 60006-0871 |
Second Address | Elk Grove Village, IL 60007-3361 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2006 |
Last Update Date | 11/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
60001714 | BC/BS NUMBER (01) | IL |
P00000748 | RR MEDICARE PIN (01) | IL |
T93184 | (02) | IL |