Provider Demographics
NPI:1477549889
Name:FLORENCE, KATHLEEN W (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:W
Last Name:FLORENCE
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 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4400 W 95TH ST STE 306
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2659
Practice Address - Country:US
Practice Address - Phone:708-684-5428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036101634208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01621490OtherBCBS PROVIDER ID
IL250011628OtherRAILROAD MEDICARE
IL47626OtherADVOCATE HLTH PARTNERS ID
IL036101634Medicaid
IL36354817310OtherADVOCATE HLTH CENTERS ID