Provider Demographics
NPI:1417026733
Name:APOSTAL, KATHY (DPM)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:
Last Name:APOSTAL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:BANOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:1921 LAKE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-1480
Mailing Address - Country:US
Mailing Address - Phone:847-256-4434
Mailing Address - Fax:847-256-4437
Practice Address - Street 1:1921 LAKE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-1480
Practice Address - Country:US
Practice Address - Phone:847-256-4434
Practice Address - Fax:847-256-4437
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003159213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT37486Medicare UPIN
IL652170Medicare ID - Type Unspecified