Healthcare Provider Details

I. General information

NPI: 1437148558
Provider Name (Legal Business Name): OSAMA KATTIH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 04/23/2022
Certification Date: 04/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE BOX 152
CHICAGO IL
60611-2605
US

IV. Provider business mailing address

225 E CHICAGO AVE BOX 152
CHICAGO IL
60611-2605
US

V. Phone/Fax

Practice location:
  • Phone: 773-880-6903
  • Fax: 773-880-3068
Mailing address:
  • Phone: 773-880-6903
  • Fax: 773-880-3068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036088874
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: