Provider Demographics
NPI:1104932326
Name:NEWHALL, KELLY KLINGLER (MD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:KLINGLER
Last Name:NEWHALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2551 N CLARK ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1798
Mailing Address - Country:US
Mailing Address - Phone:773-388-2322
Mailing Address - Fax:773-388-2333
Practice Address - Street 1:2551 N CLARK ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1798
Practice Address - Country:US
Practice Address - Phone:773-388-2322
Practice Address - Fax:773-388-2333
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036105585207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036105585Medicaid
IL036105585Medicaid