Healthcare Provider Details

I. General information

NPI: 1407801665
Provider Name (Legal Business Name): CATHERINE ANN KALLAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 06/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3048 N WILTON AVE 2ND FLOOR
CHICAGO IL
60657-6710
US

IV. Provider business mailing address

701 LEE ST SUITE 300
DES PLAINES IL
60016-4539
US

V. Phone/Fax

Practice location:
  • Phone: 773-296-5424
  • Fax:
Mailing address:
  • Phone: 847-390-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036058224
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: