Provider Demographics
NPI:1144469974
Name:KELL, JAMES (PA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:KELL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6649 W ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-2419
Mailing Address - Country:US
Mailing Address - Phone:773-586-2100
Mailing Address - Fax:773-586-2157
Practice Address - Street 1:6649 W ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-2419
Practice Address - Country:US
Practice Address - Phone:773-586-2100
Practice Address - Fax:773-586-2157
Is Sole Proprietor?:No
Enumeration Date:2009-02-18
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085000228363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL201262Medicare PIN