Kelly Park, M.D.

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

036143099 Issued in IL

Practice address

1200 Shermer Rd Ste 200
Northbrook, IL 60062-4563

Phone

(847) 559-0090

NPI assigned

Jul 1, 2010

Last updated

Oct 29, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Dr. Kelly Park Professional name

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

Northeastern Ohio University College of Medicine, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Illinois Dermatology Institute, LLCGroup PAC ID 7911043054, 51 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kpark@illinois.emadirect.md

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Illinois Dermatology Institute, LLC

  • Dermatology Physician
  • Skokie, IL
  • NPI 1891920898
  Medicare reassignment Care Compare group
• Illinois Dermatology Institute, LLC

  • Medical Specialty Clinic/Center
  • Park Ridge, IL
  • NPI 1447613989
  NPD
• Dermatology and Plastic Surgery Associates, S.C.

  • Procedural Dermatology Physician
  • Joliet, IL
  • NPI 1700987328
  NPD (past)
• North Shore Dermatology, S.C.

  • Dermatology Physician
  • Skokie, IL
  • NPI 1962508556
  NPD (past)
• Physicians Dermpath Laboratory

  • Dermatopathology Physician
  • Park Ridge, IL
  • NPI 1376866897
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1277942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761696000000",
    "number": "1659683993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 AMBERLEY CT APT 112",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "600451057",
            "telephone_number": "330-247-8419",
            "fax_number": "877-991-4957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 SHERMER RD STE 200",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600624563",
            "telephone_number": "847-559-0090"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1240 N Milwaukee Ave",
            "address_purpose": "LOCATION",
            "city": "Libertyville",
            "state": "IL",
            "postal_code": "600481307",
            "country_code": "US",
            "telephone_number": "847-367-5575",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "755 S Milwaukee Ave Ste 224",
            "address_purpose": "LOCATION",
            "city": "Libertyville",
            "state": "IL",
            "postal_code": "600483266",
            "country_code": "US",
            "telephone_number": "847-250-0138",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2500 S Highland Ave Ste 320",
            "address_purpose": "LOCATION",
            "city": "Lombard",
            "state": "IL",
            "postal_code": "601485390",
            "country_code": "US",
            "telephone_number": "815-744-8554",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1124 Essington Rd",
            "address_purpose": "LOCATION",
            "city": "Joliet",
            "state": "IL",
            "postal_code": "604358423",
            "country_code": "US",
            "telephone_number": "815-744-8554",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5000 S 5th Ave",
            "address_purpose": "LOCATION",
            "city": "Hines",
            "state": "IL",
            "postal_code": "601413030",
            "country_code": "US",
            "telephone_number": "708-202-3800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "KELLY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-01",
        "last_updated": "2025-10-29",
        "certification_date": "2025-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IL",
            "license": "036.143099",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "IL",
            "license": "036143099",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "PARK",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Lorain Pareja
• Sonny M Parikh, O.D.
• Austin Kunhee Park
• Hui Jun Park, D.D.S.
• Jin Park, ND, LAC
• Lena Park
• Pearl S. Park, DO
• Bria Parker, MHP
• Shelby Parker
• Danielle Erin Parmacek

• MOHS-Micrographic Surgery Physician in Northbrook, IL
• Providers in Northbrook, IL by specialty
• MOHS-Micrographic Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.