Provider Demographics
NPI:1073526091
Name:CLAUSEN, CATHY L (MD)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:L
Last Name:CLAUSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E CARPENTER ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62769-0001
Mailing Address - Country:US
Mailing Address - Phone:217-525-5666
Mailing Address - Fax:217-757-6754
Practice Address - Street 1:800 E CARPENTER ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62769-0001
Practice Address - Country:US
Practice Address - Phone:217-525-5666
Practice Address - Fax:217-757-6754
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
263476OtherHEALTHLINK
112254OtherHEALTH ALLIANCE
207414OtherMEDICARE GROUP NO.
IL01ZZOtherJOHN DEERE
05723077OtherBLUE CROSS GROUP#
CF8519Medicare ID - Type UnspecifiedMEDICARE RAILROAD GROUP
K24921Medicare ID - Type Unspecified
112254OtherHEALTH ALLIANCE
K24010Medicare PIN
C40154Medicare UPIN
05723077OtherBLUE CROSS GROUP#