Provider Demographics
NPI:1114345964
Name:KATHOL, DYLAN J (MD)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:J
Last Name:KATHOL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 N HALSTED ST STE 304
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-4365
Mailing Address - Country:US
Mailing Address - Phone:312-612-9667
Mailing Address - Fax:312-872-7660
Practice Address - Street 1:2001 N HALSTED ST STE 304
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-4365
Practice Address - Country:US
Practice Address - Phone:312-612-9667
Practice Address - Fax:312-872-7660
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361455622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty