Healthcare Provider Details

I. General information

NPI: 1942496435
Provider Name (Legal Business Name): DR. KATHRYN REZEK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHRYN REZEK D.D.S.

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 09/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 CHURCH ST STE. 718
EVANSTON IL
60201-4508
US

IV. Provider business mailing address

636 CHURCH ST STE. 718
EVANSTON IL
60201-4508
US

V. Phone/Fax

Practice location:
  • Phone: 184-732-8141
  • Fax: 184-732-8845
Mailing address:
  • Phone: 184-732-8141
  • Fax: 184-732-8845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019020674
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: