Healthcare Provider Details

I. General information

NPI: 1093771438
Provider Name (Legal Business Name): YASMEEN A KAGALWALLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 MAPLE RD SILVER CROSS HOSPITAL
JOLIET IL
60432
US

IV. Provider business mailing address

6965 RELIABLE PARKWAY
CHICAGO IL
60686
US

V. Phone/Fax

Practice location:
  • Phone: 815-740-1100
  • Fax: 815-740-7901
Mailing address:
  • Phone: 815-740-7073
  • Fax: 815-740-4966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number036-094277
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: