Healthcare Provider Details

I. General information

NPI: 1699121897
Provider Name (Legal Business Name): KATHRYN C RENNER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATE RENNER MD

II. Dates (important events)

Enumeration Date: 05/06/2016
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 HARTMAN LANE
SHILOH IL
62221
US

IV. Provider business mailing address

1414 CROSS ST STE 240
SHILOH IL
62269-2988
US

V. Phone/Fax

Practice location:
  • Phone: 618-641-9011
  • Fax:
Mailing address:
  • Phone: 618-234-2390
  • Fax: 618-234-9936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2016023953
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036152048
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: