Healthcare Provider Details

I. General information

NPI: 1568542975
Provider Name (Legal Business Name): KATHRYN MULCAHEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 E HAMILTON RD
BLOOMINGTON IL
61704-7527
US

IV. Provider business mailing address

207 E HAMILTON RD
BLOOMINGTON IL
61704-7527
US

V. Phone/Fax

Practice location:
  • Phone: 309-827-4090
  • Fax:
Mailing address:
  • Phone: 309-827-4090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036-092871
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: