Healthcare Provider Details

I. General information

NPI: 1184670416
Provider Name (Legal Business Name): KATHLEEN KUO-STARR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 07/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 E ERIE ST SUITE 304
CHICAGO IL
60611-2926
US

IV. Provider business mailing address

233 E ERIE ST SUITE 304
CHICAGO IL
60611-2926
US

V. Phone/Fax

Practice location:
  • Phone: 312-280-1480
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036104793
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: