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General NPI Number Information
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NPI Number | 1295411171
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Entity Type | Individual
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Provider Name | KATHRYN LYALL HALLDIN PA
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Gender | Female
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Dates
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Enumeration Date | 06/26/2023
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 3000 N HALSTED ST STE 625
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City | CHICAGO
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State | IL
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Zip | 60657-5196
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Country | US
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Telephone | 773-296-6666
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Fax | 773-296-9999
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Provider Business Mailing Address
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Address Line | 29373 NETWORK PL
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City | CHICAGO
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State | IL
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Zip | 60673-1293
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Country | US
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Telephone |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085-009832
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License Number State | IL
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