Provider Demographics
NPI:1073045266
Name:VANBUSKIRK, KATHRYN (DO)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:
Last Name:VANBUSKIRK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:VANBUSKIRK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:1010 LAKE ST STE 301
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1133
Mailing Address - Country:US
Mailing Address - Phone:330-904-4138
Mailing Address - Fax:
Practice Address - Street 1:1010 LAKE ST STE 301
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1133
Practice Address - Country:US
Practice Address - Phone:708-524-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036153029207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine