Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kelly Lenneman

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1588338172

Kelly Lenneman is a Physician Assistant in Evergreen Park, Illinois. Qualified in 2021, 5 years ago. Practices with Bonaventure Medical Foundation LLC, a 165-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
5
Licensed in
IL
In the registry since
2021
Specialties on file
2
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Practice location Address checks out

3749 W 95th St
Evergreen Park, IL 60805-2019
Phone: (844) 372-7672
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 2647 S Xenon Way, Lakewood, CO 80228-4941 — (303) 601-0865

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X (IL)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1588338172
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedAugust 6, 2021
Last updated in NPPESDecember 8, 2021
Certification dateDecember 8, 2021
Mailing address2647 S Xenon Way, Lakewood, CO 80228-4941

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Bonaventure Medical Foundation Llc — 165 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Evergreen Park