Healthcare Provider Details

I. General information

NPI: 1689503088
Provider Name (Legal Business Name): PHILLIP KALTENTHALER OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 WAVERLY DR
ELGIN IL
60120-4082
US

IV. Provider business mailing address

3450 LACEY RD
DOWNERS GROVE IL
60515-5430
US

V. Phone/Fax

Practice location:
  • Phone: 847-697-7771
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: