MEDICARE: KATHRYN J MENCEL M.D.

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	207Q00000X	Family Medicine Physician	036-103885	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1632546	OTHER	IL	BC/BS

General Provider Information

NPI Number	:	1538113956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN J MENCEL M.D.

Provider Business Mailing Address
First Line	:	7740 W NORTH AVE
Second Line	:
City	:	ELMWOOD PARK
State	:	IL
Zip	:	60707-4124
Country	:	US
Telephone Number	:	708-456-3200
Fax Number	:	708-456-3427

Provider Business Practice Location Address
First Line	:	7740 W NORTH AVE
Second Line	:
City	:	ELMWOOD PARK
State	:	IL
Zip	:	60707-4124
Country	:	US
Telephone Number	:	708-456-3200
Fax Number	:	708-456-3427

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

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	01/19/2010

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