Healthcare Provider Details

I. General information

NPI: 1336943919
Provider Name (Legal Business Name): KATE SLOAN FAHEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2025
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 S 1ST AVE
MAYWOOD IL
60153-3328
US

IV. Provider business mailing address

1460 N SANDBURG TER APT 407A
CHICAGO IL
60610-5551
US

V. Phone/Fax

Practice location:
  • Phone: 708-216-9000
  • Fax: 708-216-0899
Mailing address:
  • Phone: 309-740-8012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number125085826
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: