Provider Demographics
NPI:1093771438
Name:KAGALWALLA, YASMEEN A (MD)
Entity Type:Individual
Prefix:
First Name:YASMEEN
Middle Name:A
Last Name:KAGALWALLA
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 1:6965 RELIABLE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60686
Mailing Address - Country:US
Mailing Address - Phone:815-740-7073
Mailing Address - Fax:815-740-4966
Practice Address - Street 1:1200 MAPLE RD
Practice Address - Street 2:SILVER CROSS HOSPITAL
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60432
Practice Address - Country:US
Practice Address - Phone:815-740-1100
Practice Address - Fax:815-740-7901
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-094277207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL220026450OtherRR MC
IL0360942771Medicaid
IL220026450OtherRR MC
IL0360942771Medicaid