Healthcare Provider Details

I. General information

NPI: 1225923329
Provider Name (Legal Business Name): KATHERINE RIORDAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2025
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W HARRISON ST STE 855
CHICAGO IL
60612-5113
US

IV. Provider business mailing address

1725 W HARRISON ST STE 855
CHICAGO IL
60612-5113
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-6644
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number125086087
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: