Healthcare Provider Details

I. General information

NPI: 1205415023
Provider Name (Legal Business Name): HANNAH CATHERINE LICHOTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HANNAKATE HALL

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 MCCLINTOCK DR
BURR RIDGE IL
60527-0871
US

IV. Provider business mailing address

901 MCCLINTOCK DR
BURR RIDGE IL
60527-0871
US

V. Phone/Fax

Practice location:
  • Phone: 888-220-6432
  • Fax:
Mailing address:
  • Phone: 888-220-6432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.077894
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number036.169408
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: