Provider Demographics
NPI:1114986296
Name:CRONIN, CATHLEEN (MD)
Entity Type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:
Last Name:CRONIN
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 1:2160 S FIRST AVE
Mailing Address - Street 2:LUH-NO ENT., RM. 2601
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:708-216-3408
Mailing Address - Fax:708-216-3557
Practice Address - Street 1:2160 S FIRST AVE
Practice Address - Street 2:LUH-NO ENT., RM. 2601
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-216-3408
Practice Address - Fax:708-216-3557
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36060292207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36060292Medicaid
IL36060292Medicaid