Healthcare Provider Details

I. General information

NPI: 1669496550
Provider Name (Legal Business Name): KATHLEEN D. MATHES DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15931 S BELL RD
HOMER GLEN IL
60491-6707
US

IV. Provider business mailing address

15931 S BELL RD
HOMER GLEN IL
60491-6707
US

V. Phone/Fax

Practice location:
  • Phone: 708-301-3080
  • Fax: 708-301-6198
Mailing address:
  • Phone: 708-301-3080
  • Fax: 708-301-6198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number016002942
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: