Healthcare Provider Details

I. General information

NPI: 1932593340
Provider Name (Legal Business Name): KATHERINE ELLE TRIBBLE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2015
Last Update Date: 01/31/2022
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 N WINFIELD RD
WINFIELD IL
60190-1379
US

IV. Provider business mailing address

225 E CHICAGO AVE # 152
CHICAGO IL
60611-2991
US

V. Phone/Fax

Practice location:
  • Phone: 630-933-2340
  • Fax:
Mailing address:
  • Phone: 630-933-2340
  • Fax: 630-933-2654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA148128
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number125066653
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.148773
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: