Provider Demographics
NPI:1558385831
Name:BRINDL, CATHLEEN T (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CATHLEEN
Middle Name:T
Last Name:BRINDL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CATHLEEN
Other - Middle Name:T
Other - Last Name:KRESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:680 N LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4546
Mailing Address - Country:US
Mailing Address - Phone:312-695-6868
Mailing Address - Fax:
Practice Address - Street 1:501 THORNHILL DRIVE
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188
Practice Address - Country:US
Practice Address - Phone:630-286-6982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085002287363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00182811OtherRR MEDICARE GRP ID#
IL210491OtherMEDICARE GRP PROVIDER #
ILCJ3182OtherRR MEDICARE ID#
ILQ30321Medicare UPIN
ILK12827Medicare ID - Type Unspecified