Healthcare Provider Details

I. General information

NPI: 1083860142
Provider Name (Legal Business Name): KATIE MEGHAN MCCABE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2008
Last Update Date: 08/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1653 W CONGRESS PKWY
CHICAGO IL
60612-3833
US

IV. Provider business mailing address

1537 W BARRY AVE APT 2
CHICAGO IL
60657-3105
US

V. Phone/Fax

Practice location:
  • Phone: 313-942-5046
  • Fax:
Mailing address:
  • Phone: 313-682-0631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number051160
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: