Healthcare Provider Details

I. General information

NPI: 1437362035
Provider Name (Legal Business Name): KATHLEEN ELYN O'MARA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN ELYN SCHROEDER DO

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 E LAYTON AVE
ST FRANCIS WI
53235-6053
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 414-744-6589
  • Fax:
Mailing address:
  • Phone: 800-326-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number5101016080
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number3970
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number54446
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: