Provider Demographics
NPI:1538113956
Name:MENCEL, KATHRYN J (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:J
Last Name:MENCEL
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 1:7740 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60707-4124
Mailing Address - Country:US
Mailing Address - Phone:708-456-3200
Mailing Address - Fax:708-456-3427
Practice Address - Street 1:7740 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:IL
Practice Address - Zip Code:60707-4124
Practice Address - Country:US
Practice Address - Phone:708-456-3200
Practice Address - Fax:708-456-3427
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-103885207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036103885Medicaid
IL1632546OtherBC/BS
IL202411Medicare ID - Type Unspecified
IL036103885Medicaid