Provider Demographics
NPI:1568481372
Name:KUEBEL, KATHERINE MARIE (PT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARIE
Last Name:KUEBEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-8813
Mailing Address - Country:US
Mailing Address - Phone:630-575-6250
Mailing Address - Fax:630-575-7450
Practice Address - Street 1:2820 W ARMITAGE AVE STE 7
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-6318
Practice Address - Country:US
Practice Address - Phone:773-394-0796
Practice Address - Fax:773-394-3342
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-014323174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL200573902OtherTAX IDENTIFICATION NO.
IL363396874OtherTAX IDENTIFICATION NO.
IL1618443OtherBCBS GROUP NO.
IL01634372OtherBCBS GROUP NO.
IL236963283001Medicaid
IL210877Medicare ID - Type UnspecifiedMEDICARE GROUP NO.
IL209881Medicare ID - Type UnspecifiedMEDICARE GROUP NO.
IL01634372OtherBCBS GROUP NO.