Healthcare Provider Details

I. General information

NPI: 1619157526
Provider Name (Legal Business Name): KATHLEEN JOSEPHINE SLUGOCKI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10260 191ST ST STE 100
MOKENA IL
60448-8801
US

IV. Provider business mailing address

10260 191ST ST STE 100
MOKENA IL
60448-8801
US

V. Phone/Fax

Practice location:
  • Phone: 708-425-1907
  • Fax: 708-469-4358
Mailing address:
  • Phone: 708-425-1907
  • Fax: 708-469-4358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036120113
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number89987440
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: