| Provider / Organization | NPI | Date Certified |
|---|---|---|
| LANCE KELLY | 1831694892 | 2022-06-26 |
Lance Kelly is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1831694892. Registration indicates Lance Kelly is a provider of services with a specialization in Allopathic & Osteopathic Physicians, Anesthesiology (Anesthesiology, ) (All Other Specialties & Provider Types, ) (Anesthesiology, Allopathic & Osteopathic Physicians) (Allopathic & Osteopathic Physicians, Anesthesiology) (Anesthesiology, ) (All Other Specialties & Provider Types, ) (Anesthesiology, Allopathic & Osteopathic Physicians)
| Registration | PART-B:Y DME:Y HHA:Y PMD:Y |
| Entity Type | Individual |
| Provider Name | Dr. Lance Kelly MD |
| Practice Office Address | 2160 S 1ST AVE MAYWOOD, IL US |
| Practice Office Telephone | 7082169169 |
| Practice Office Fax | 7082161249 |
| Mailing Address | 2160 S 1ST AVE MAYWOOD, IL 601533328 US |
| Business Telephone | 5052205446 |
| Direct Messaging Address [] | [email protected] | Direct |
| Code | Practice | License No State |
|---|---|---|
| 207L00000X | Allopathic & Osteopathic Physicians Anesthesiology Anesthesiology All Other Specialties & Provider Types Anesthesiology Allopathic & Osteopathic Physicians | 125.072310
IL |
| 207L00000X PRIMARY | Allopathic & Osteopathic Physicians Anesthesiology Anesthesiology All Other Specialties & Provider Types Anesthesiology Allopathic & Osteopathic Physicians | 036154058
IL |
| 193200000X MULT | Group Code |