MEDICARE: KATHERINE GALLO

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1831026632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE GALLO

Provider Business Mailing Address
First Line	:	118 ALLEN CT
Second Line	:
City	:	CLARENDON HILLS
State	:	IL
Zip	:	60514-1466
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	21202 OWENS RD STE 300
Second Line	:
City	:	MOKENA
State	:	IL
Zip	:	60448-2038
Country	:	US
Telephone Number	:	779-334-0010
Fax Number	:

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

Provider Enumeration Date	:	05/06/2026
Last Update Date	:	05/06/2026

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Directions to “ KATHERINE GALLO ” Practice Location

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