Healthcare Provider Details

I. General information

NPI: 1881680361
Provider Name (Legal Business Name): GARRETT KATULA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 VETERANS PKWY. SUITE 200
YORKVILLE IL
60560-1095
US

IV. Provider business mailing address

1100 W VETERANS PKWY STE 200
YORKVILLE IL
60560-4728
US

V. Phone/Fax

Practice location:
  • Phone: 630-236-4270
  • Fax: 630-236-4271
Mailing address:
  • Phone: 630-236-4270
  • Fax: 630-236-4271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-092138
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: