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

Kelly Shi Thao, MD

Individual provider Family Medicine Physician · NPI 1588307441

Kelly Shi Thao, MD is a Family Practice in Park Ridge, Illinois. Qualified in 2022, 4 years ago. Practices with Fairview Clinics, a 806-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Minnesota.

Years since qualifying
4
Licensed in
MN
In the registry since
2022
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1775 Dempster St
Park Ridge, IL 60068-1143
Phone: (847) 318-2710
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1414 Maryland Ave E, Saint Paul, MN 55106-2824 — (651) 772-3461

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 77739 (MN)

Record details

NPI number1588307441
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorNo
NPI enumeratedApril 19, 2022
Last updated in NPPESApril 9, 2026
Certification dateApril 9, 2026

Medicare enrollment

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

Medicare specialtyFAMILY PRACTICE
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Fairview Clinics — 806 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations8 on file with Medicare

Other providers in Park Ridge