Provider Demographics
NPI:1174831168
Name:CHARTRE, KATHYA M (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHYA
Middle Name:M
Last Name:CHARTRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHYA
Other - Middle Name:M
Other - Last Name:VALDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:121 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-1315
Mailing Address - Country:US
Mailing Address - Phone:312-643-5606
Mailing Address - Fax:
Practice Address - Street 1:4025 N SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-2010
Practice Address - Country:US
Practice Address - Phone:773-388-1600
Practice Address - Fax:773-388-8936
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.058223207Q00000X
IL036.133054207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036133054Medicaid