Healthcare Provider Details

I. General information

NPI: 1679150494
Provider Name (Legal Business Name): KATHRYN BRADY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 HARLEM AVE
NORTH RIVERSIDE IL
60546-1470
US

IV. Provider business mailing address

1950 HARLEM AVE
NORTH RIVERSIDE IL
60546-1470
US

V. Phone/Fax

Practice location:
  • Phone: 708-354-9250
  • Fax: 708-354-8765
Mailing address:
  • Phone: 708-354-9250
  • Fax: 708-354-8765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.166666
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: