Healthcare Provider Details

I. General information

NPI: 1275620734
Provider Name (Legal Business Name): CATHY J HALPERIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 S WILLOW SPRINGS RD STE 490
LAGRANGE IL
60525
US

IV. Provider business mailing address

PO BOX 713260
CHICAGO IL
60677-1260
US

V. Phone/Fax

Practice location:
  • Phone: 708-352-4630
  • Fax: 708-352-8348
Mailing address:
  • Phone: 630-469-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036087919
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: