Healthcare Provider Details

I. General information

NPI: 1588026603
Provider Name (Legal Business Name): KATHERINE MARETTE TADROS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 10/10/2023
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 W WELLINGTON AVE
CHICAGO IL
60657-5147
US

IV. Provider business mailing address

1875 DEMPSTER ST STE 245
PARK RIDGE IL
60068-1126
US

V. Phone/Fax

Practice location:
  • Phone: 773-975-1600
  • Fax:
Mailing address:
  • Phone: 847-692-9234
  • Fax: 847-692-5267

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 State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036.151964
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: