Provider Demographics
NPI:1508152315
Name:KATERJI, BASEL (MD)
Entity Type:Individual
Prefix:DR
First Name:BASEL
Middle Name:
Last Name:KATERJI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4444 PRESCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:IL
Mailing Address - Zip Code:60534-1932
Mailing Address - Country:US
Mailing Address - Phone:872-282-0400
Mailing Address - Fax:872-871-0005
Practice Address - Street 1:4444 PRESCOTT AVE
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:IL
Practice Address - Zip Code:60534-1932
Practice Address - Country:US
Practice Address - Phone:872-282-0400
Practice Address - Fax:872-871-0005
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036135416208000000X
WI62123208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036135416Medicaid