Active NPI
Kelly E Guglielmi, M.D.
- Nephrology Physician
- Evergreen Park, IL
National Provider Identifier
1174556781
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- License
- 036094134
- Practice address
- 9125 S Pulaski Rd
Evergreen Park, IL 60805-1441 - Phone
- (708) 422-7715
- Fax
- (708) 422-7816
- NPI assigned
- Jul 8, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | 036094134 | IL | Primary |
Addresses
Primary practice location
9125 S Pulaski Rd
Evergreen Park, IL 60805-1441
Mailing address
4440 W. 95TH Street
Oak Lawn, IL 60453
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036094134 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152316800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1499990400000",
"number": "1174556781",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4440 W. 95TH STREET",
"city": "OAK LAWN",
"state": "IL",
"postal_code": "60453"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9125 S PULASKI RD",
"city": "EVERGREEN PARK",
"state": "IL",
"postal_code": "608051441",
"telephone_number": "708-422-7715",
"fax_number": "708-422-7816"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUGLIELMI",
"first_name": "KELLY",
"middle_name": "E",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-08",
"last_updated": "2017-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "207RN0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Nephrology",
"state": "IL",
"license": "036094134",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036094134",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Evergreen Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.