Healthcare Provider Details

I. General information

NPI: 1053714576
Provider Name (Legal Business Name): KATHLEEN A FINNEKE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHLEEN A GEORGIA PA-C

II. Dates (important events)

Enumeration Date: 09/29/2014
Last Update Date: 02/12/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2073 N CLYBOURN AVE
CHICAGO IL
60614-4003
US

IV. Provider business mailing address

6216 SCOTT ST
ROSEMONT IL
60018-4323
US

V. Phone/Fax

Practice location:
  • Phone: 773-665-4016
  • Fax: 773-360-6200
Mailing address:
  • Phone: 920-265-5763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085005260
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: