Healthcare Provider Details

I. General information

NPI: 1003800129
Provider Name (Legal Business Name): KARIN KALLWITZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 E BELVIDERE RD STE 106
GRAYSLAKE IL
60030-2061
US

IV. Provider business mailing address

1170 E BELVIDERE RD STE 106
GRAYSLAKE IL
60030-2061
US

V. Phone/Fax

Practice location:
  • Phone: 847-548-7337
  • Fax: 847-548-9909
Mailing address:
  • Phone: 847-548-7337
  • Fax: 847-548-9909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: