Provider Demographics
NPI:1033287024
Name:GRACE, KATHRYN S (DPM)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:S
Last Name:GRACE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 COMPASS RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-8000
Mailing Address - Country:US
Mailing Address - Phone:847-729-9580
Mailing Address - Fax:847-729-9480
Practice Address - Street 1:2501 COMPASS RD
Practice Address - Street 2:SUITE 120
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-8000
Practice Address - Country:US
Practice Address - Phone:847-729-9580
Practice Address - Fax:847-729-9480
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003845213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00208698OtherRAILROAD MEDICARE
ILT38774Medicare UPIN
ILK07446Medicare ID - Type Unspecified