Healthcare Provider Details

I. General information

NPI: 1699064857
Provider Name (Legal Business Name): KATHERINE LOUISE WELKER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2011
Last Update Date: 12/01/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1917 W EVERGREEN AVE APT 3R
CHICAGO IL
60622-4793
US

IV. Provider business mailing address

1900 W POLK ST 10TH FLOOR
CHICAGO IL
60612-3723
US

V. Phone/Fax

Practice location:
  • Phone: 619-201-3982
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License Number036135583
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036135583
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: