Healthcare Provider Details

I. General information

NPI: 1053606475
Provider Name (Legal Business Name): KATIE ELIZABETH LIMARDI D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 06/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 W WELLINGTON AVE ADVOCATE ILLINOIS MASONIC MEDICAL CENTER
CHICAGO IL
60657-5123
US

IV. Provider business mailing address

1307 S WABASH AVE #602
CHICAGO IL
60605-2620
US

V. Phone/Fax

Practice location:
  • Phone: 773-871-1461
  • Fax:
Mailing address:
  • Phone: 847-452-3886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019028618
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: