Provider Demographics
NPI:1467942409
Name:GHANAYEM KUBILIUS, KATHRYN MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:MARIA
Last Name:GHANAYEM KUBILIUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:M
Other - Last Name:GHANAYEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3329 75TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-8137
Mailing Address - Country:US
Mailing Address - Phone:630-646-6750
Mailing Address - Fax:630-548-7654
Practice Address - Street 1:3329 75TH ST
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517
Practice Address - Country:US
Practice Address - Phone:630-646-6750
Practice Address - Fax:630-548-7654
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036155938207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine