GREEN DRAGONFLY
NPI 1407008998
Clinic/Center in Waukegan, IL

Q: What is The Illinois Medical Assistance Treatment Program LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.

Active since October 16, 2008

1738 WASHINGTON ST, WAUKEGAN, IL 60085(847) 360-1019(847) 360-6277 Get Directions Write a Review

NPPES record last updated: October 16, 2008. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Green Dragonfly NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GREEN DRAGONFLY (NPI 1407008998) is a healthcare organization registered as a clinic/center in Waukegan, Illinois and active in the NPI registry since October 2008. The organization lists Richard L Keller, Medical Director, as its authorized official.

NPPES Registry Identity

NPI1407008998

Entity TypeOrganization

Primary Taxonomy261Q00000X

Legal Business NameTHE ILLINOIS MEDICAL ASSISTANCE TREATMENT PROGRAM LLC

Location Address1738 WASHINGTON STWaukegan, IL 60085-5137

Mailing Address1738 Washington StWaukegan, IL 60085-5137 · (847) 360-1019 · Fax (847) 360-6277

Phone(847) 360-1019

Fax(847) 360-6277

Organization SubpartNo

Authorized OfficialRichard L KellerMedical Director · (847) 360-1019

Enumeration DateOctober 16, 2008

✔ NPI 1407008998 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/CenterAmbulatory Health Care Facilities

Taxonomy Code261Q00000X

License✔ Licensed in IL · A27740001A

Definition

A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

1738 WASHINGTON ST, Waukegan, IL 60085

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Other Names 1

Other NameGreen Dragonfly

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

RICHARD LORAN KELLER M.D.

Family Medicine

1738 WASHINGTON ST
WAUKEGAN, IL 60085

Lake County (847) 360-1019

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is The Illinois Medical Assistance Treatment Program LLC's NPI number?

The NPI number for The Illinois Medical Assistance Treatment Program LLC is 1407008998. It was assigned to this organization in the NPPES registry on October 16, 2008. The provider is also known as Green Dragonfly.

Where is The Illinois Medical Assistance Treatment Program LLC located?

The Illinois Medical Assistance Treatment Program LLC is located at 1738 Washington St, Waukegan, IL 60085. The listed phone number is (847) 360-1019.

What is The Illinois Medical Assistance Treatment Program LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.

When was this NPI record last updated?

The NPPES record for The Illinois Medical Assistance Treatment Program LLC was last updated on October 16, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.