Healthcare Provider Details

I. General information

NPI: 1942755426
Provider Name (Legal Business Name): CATHERINE IVES-LOUTER MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2016
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 N PARKSIDE AVE
CHICAGO IL
60644-3040
US

IV. Provider business mailing address

115 N PARKSIDE AVE
CHICAGO IL
60644-3040
US

V. Phone/Fax

Practice location:
  • Phone: 773-295-3060
  • Fax: 773-295-3065
Mailing address:
  • Phone: 773-295-3060
  • Fax: 773-295-3065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036.163498
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: