Provider Demographics
NPI:1558526186
Name:PETRUNGARO, KATHRYN M (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:M
Last Name:PETRUNGARO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:600 CENTRAL AVE STE 333
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-5605
Mailing Address - Country:US
Mailing Address - Phone:847-535-7157
Mailing Address - Fax:312-694-1700
Practice Address - Street 1:2701 PATRIOT BLVD
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-8039
Practice Address - Country:US
Practice Address - Phone:847-535-7157
Practice Address - Fax:847-998-9221
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2020-03-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036124573208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist