| Doctor Name: | SEAN MICHAEL KELLY |
| NPI Number: | 1215378740 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | GNP-BC |
| License Number: | 209010500 |
| Business Practice Address: | 550 Warrenville Rd Suite 300 Lisle, IL - 605324308 |
| Business Phone Number: | 7733329616 |
| Business Fax Number: | |
| Mailing Address: | 550 Warrenville Rd, Suite 300 LISLE |
| State: | IL |
| Postal Code: | 605324308 |
| Phone Number: | 7733329616 |
| Fax Number: | |
| NPI Enumeration Date: | 07/12/2013 |
| NPI Last Update Date: | 10/14/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LG0600X |
| License Number: | 209010500 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Gerontology |
| Taxonomy Definition: | |