Provider Demographics
NPI:1619157526
Name:SLUGOCKI, KATHLEEN JOSEPHINE (DO)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:JOSEPHINE
Last Name:SLUGOCKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10260 191ST ST
Mailing Address - Street 2:STE 100
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-8801
Mailing Address - Country:US
Mailing Address - Phone:708-425-1907
Mailing Address - Fax:708-469-4358
Practice Address - Street 1:10260 191ST ST
Practice Address - Street 2:STE 100
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8801
Practice Address - Country:US
Practice Address - Phone:708-425-1907
Practice Address - Fax:708-469-4358
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036120113207V00000X
IL899874402083B0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036120113Medicaid
ILP01079495Medicare UPIN
ILF400119108Medicare PIN