Provider Demographics
NPI:1609056654
Name:GAMBETTA, KATHERYN ELLEN (MD)
Entity Type:Individual
Prefix:
First Name:KATHERYN
Middle Name:ELLEN
Last Name:GAMBETTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2300 N CHILDRENS PLZ
Mailing Address - Street 2:BOX 21
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-3363
Mailing Address - Country:US
Mailing Address - Phone:773-880-4553
Mailing Address - Fax:773-880-8111
Practice Address - Street 1:2300 N CHILDRENS PLZ
Practice Address - Street 2:BOX 21
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3363
Practice Address - Country:US
Practice Address - Phone:773-880-4553
Practice Address - Fax:773-880-8111
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL0361048522080P0202X
IN99028739A2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology