Healthcare Provider Details

I. General information

NPI: 1427686963
Provider Name (Legal Business Name): KATHERINA RENATE BOETTGE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST
CHICAGO IL
60612-7232
US

IV. Provider business mailing address

1525 SPICED WINE AVE UNIT 23102
HENDERSON NV
89074-0181
US

V. Phone/Fax

Practice location:
  • Phone: 866-600-2273
  • Fax:
Mailing address:
  • Phone: 702-773-6176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number036169765
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: