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General NPI Number Information
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NPI Number | 1932593340
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Entity Type | Individual
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Provider Name | KATHERINE ELLE TRIBBLE M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/24/2015
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Last Update Date | 01/31/2022
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Provider Practice Location Address
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Address Line | 25 N WINFIELD RD
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City | WINFIELD
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State | IL
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Zip | 60190-1379
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Country | US
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Telephone | 630-933-2340
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Fax |
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Provider Business Mailing Address
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Address Line | 225 E CHICAGO AVE # 152
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City | CHICAGO
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State | IL
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Zip | 60611-2991
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Country | US
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Telephone | 630-933-2340
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Fax | 630-933-2654
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A148128
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 125066653
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036.148773
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License Number State | IL
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