Healthcare Provider Details

I. General information

NPI: 1558526186
Provider Name (Legal Business Name): KATHRYN M PETRUNGARO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2008
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SKOKIE BLVD STE 405
NORTHBROOK IL
60062-7904
US

IV. Provider business mailing address

600 CENTRAL AVE STE 333
HIGHLAND PARK IL
60035-5605
US

V. Phone/Fax

Practice location:
  • Phone: 224-215-8585
  • Fax: 224-296-1951
Mailing address:
  • Phone: 847-535-7157
  • Fax: 312-694-1700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036124573
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036124573
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: