Healthcare Provider Details

I. General information

NPI: 1609027168
Provider Name (Legal Business Name): KENDRA MARSH-KATES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KENDRA MARSH M.D.

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 W 203RD ST STE 204
OLYMPIA FIELDS IL
60461-1185
US

IV. Provider business mailing address

35318 EAGLE WAY
CHICAGO IL
60678-1353
US

V. Phone/Fax

Practice location:
  • Phone: 708-679-2670
  • Fax: 708-503-3260
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number53352-20
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036115455
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: