Provider Demographics
NPI:1104057843
Name:KELLY, MELISSA MARIE (DO)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIE
Last Name:KELLY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:MARIE
Other - Last Name:DOWDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1000 REMINGTON BLVD
Mailing Address - Street 2:SUITE 200 ATTN: AIM
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-5114
Mailing Address - Country:US
Mailing Address - Phone:630-312-7755
Mailing Address - Fax:
Practice Address - Street 1:1000 REMINGTON BLVD
Practice Address - Street 2:SUITE 200 ATTN: AIM
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-5114
Practice Address - Country:US
Practice Address - Phone:630-312-7755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.128764207R00000X
IL036-128764208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine