Kelly, Tania

Kelly, Tania is an individual health care provider with primary practice located at 4440 W 95Th St , Oak Lawn IL 60453-2600. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Kelly, Tania can be contacted via phone (708) 684-5341.

Contact Information

Primary practice address
4440 W 95Th St Oak Lawn IL 60453-2600
Fax: (708) 684-4767
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 036112183 Illinois

Profile Details

NPI number 1457443384
LBN Legal business name Kelly, Tania
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 28th, 2006
Last updated Mar 16th, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1457443384 NPPES
Illinois MEDICAID 036112183

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