MEDICARE: KATHRYN OCCHIPINTI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	036-099304	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	300097484	OTHER	IL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	IL0100	OTHER	IL	JOHN DEERE
3	0007222342	OTHER	IL	BLUE CROSS BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	3446903	OTHER	IL	ACR
6	405209	OTHER	IL	HEALTHLINK
7	055131	OTHER	IL	HEALTH ALLIANCE
8	370947902	OTHER	IL	TRICARE CHAMPUS

General Provider Information

NPI Number	:	1194703819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN OCCHIPINTI MD

Provider Business Mailing Address
First Line	:	5212 N ROTHMERE DR
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61615-9302
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1770 IOWA AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-2430
Country	:	US
Telephone Number	:	309-231-3297
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	02/04/2015

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Directions to “ KATHRYN OCCHIPINTI MD” Practice Location

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