MARY L. KELLY, D.O., S.C. (NPI# 1649573882) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649573882 |
| Entity Type | Organization |
| Organization Name | MARY L. KELLY, D.O., S.C. |
| Practice Address |
1125 Westgate St Oak Park IL 60301-1007 |
| Practice Telephone | 7088480040 |
| Practice Fax Number | 7088482931 |
| Mailing Telephone | 7088480040 |
| Mailing Fax Number | 7088482931 |
| Enumeration Date | 2010-12-09 |
| Last Update Date | 2013-12-18 |
| Authorized Official Name | MARY LOUISE KELLY (PRESIDENT) |
| Authorized Official Telephone | 7088480040 |
| Authorized Official Credential | D.O. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
036077560 | IL | Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497903314 | Mary L. Kelly, D.o., S.c. | Clinic/Center | 7319 North Ave, River Forest, IL 60305-1220 | 2008-09-04 |
| Street Address |
1125 WESTGATE ST |
| City | OAK PARK |
| State | IL |
| Zip Code | 60301-1007 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912087560 | Mary Louise Kelly | Family Medicine | 1125 Westgate St, Oak Park, IL 60301-1007 | 2006-10-17 |
| 1639299712 | Westgate Orthopaedics, Ltd. | Orthopaedic Surgery | 1125 Westgate St, Oak Park, IL 60301-1007 | 2007-03-30 |
| 1720138746 | River Forest Medical Center Incorporated | Family Medicine | 1125 Westgate St, Oak Park, IL 60301-1007 | 2007-01-11 |
| 1992884423 | Edward Boone Brackett IIi | Orthopaedic Surgery | 1125 Westgate St, Oak Park, IL 60301-1007 | 2006-11-03 |
| 1437231057 | Mark Cavalenes | Orthopaedic Surgery | 1125 Westgate St, Oak Park, IL 60301-1007 | 2006-10-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457982332 | Heather Lea Corwin | Counselor | Blackbird Behavioral Health, 715 Lake Street, 4th Floor, Oak Park, IL 60301 | 2020-01-30 |
| 1194244400 | Kristin Burns Mind and Body | Clinic/Center | 715 Lake St Ste 703, Oak Park, IL 60301 | 2017-09-18 |
| 1538686357 | Highland Park Cvs LLC | Durable Medical Equipment & Medical Supplies | 1129 Lake St., Oak Park, IL 60301 | 2017-08-23 |
| 1851835888 | Wanda Secthecia Presley | Nurse's Aide | 1140 South Lake Street, Oak Park, IL 60301 | 2016-12-09 |
| 1477914323 | Naomi Elise Heinz | Occupational Therapist | 820 North Boulevard, Kids Unlimited Therapy Services, LLC, Oak Park, IL 60301 | 2016-03-18 |
| 1316339518 | Christina Shrader | Counselor | 137 N Oak Park Ave Ste 123, Oak Park, IL 60301 | 2015-02-24 |
| 1356755334 | Grief Recovery Group, Inc | Social Worker | 1010 Lake Street, Suite 620, Oak Park, IL 60301 | 2014-06-17 |
| 1700137239 | Christine Marie Hare | Nurse Practitioner | 1100 Lake St Ste 120, Oak Park, IL 60301 | 2012-09-24 |
| 1427334622 | Ina N. Owens | Social Worker | 137 N. Oak Park Ave, Oak Park, IL 60301 | 2011-11-01 |
| 1265720130 | Debora S Crowley | Occupational Therapist | 820 North Blvd., Oak Park, IL 60301 | 2011-07-13 |
| Find all providers in zip 60301 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225346885 | Kinfe Gebeyehu | Clinic/Center | 1125 Clinton Ave, Oak Park, IL 60304-1825 | 2010-09-16 |
| 1295900322 | Urban Home Physicians, Inc. | Clinic/Center | 408 Madison St, Oak Park, IL 60302-4091 | 2008-04-29 |
| 1154376234 | Dacia Medical Professional Corporation | Clinic/Center | 917 S Oak Park Ave, Suite B, Oak Park, IL 60304-1950 | 2006-05-24 |
| 1740744895 | Pipeline - Lakefront Medical Associates, LLC | Clinic/Center | 3 Erie Ct, Oak Park, IL 60302-2519 | 2019-01-23 |
| 1932672391 | Pipeline - Lakefront Medical Associates, LLC | Clinic/Center | 3 Erie Ct, Oak Park, IL 60302-2519 | 2019-01-09 |
| 1437544350 | Dabaja Medical Consulting Pllc | Clinic/Center | 24661 Coolidge Hwy, Oak Park, MI 48237-1449 | 2015-03-30 |
| 1174947543 | Dabaja Medical Consulting | Clinic/Center | 24661 Coolidge Hwy, Oak Park, MI 48237-1449 | 2014-02-06 |
| 1790115517 | Datta Sambare Md Sc | Clinic/Center | 6957 North Ave, Oak Park, IL 60302-1068 | 2013-11-14 |
| 1861750036 | D.o.c, Family Practice, S.c. | Clinic/Center | 6300 Roosevelt Rd, Oak Park, IL 60304-2303 | 2012-04-25 |
| 1700180171 | Oak Park Pediatrics Ltd. | Clinic/Center | 1107 Chicago Ave, Oak Park, IL 60302-1803 | 2010-12-28 |
| Find all providers in OAK PARK | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.