Healthcare Provider Details

I. General information

NPI: 1932363447
Provider Name (Legal Business Name): KATHLEEN WREN PHELAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHLEEN BENEDICTA WREN M.D.

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 W HARRISON ST
CHICAGO IL
60607-3106
US

IV. Provider business mailing address

1520 W HARRISON ST
CHICAGO IL
60607-3106
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-5904
  • Fax:
Mailing address:
  • Phone: 312-942-5904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number036121454
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number036121454
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: