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General NPI Number Information
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NPI Number | 1104474212
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Entity Type | Individual
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Provider Name | BETH KATHAN
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Gender | Female
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Dates
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Enumeration Date | 09/01/2019
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Last Update Date | 09/01/2019
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Provider Practice Location Address
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Address Line | 4300 COMMERCE CT STE 318
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City | LISLE
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State | IL
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Zip | 60532-3698
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Country | US
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Telephone | 630-686-2626
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Fax |
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Provider Business Mailing Address
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Address Line | 5747 W WARWICK AVE
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City | CHICAGO
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State | IL
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Zip | 60634-2658
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Country | US
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Telephone | 773-610-4234
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 198001464
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License Number State | IL
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