Provider Demographics
NPI:1629062849
Name:KAMHOLZ, KATHERINE NANCY (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:NANCY
Last Name:KAMHOLZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:912 NORTHWEST HWY
Mailing Address - Street 2:STE G5A
Mailing Address - City:FOX RIVER GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60021-1925
Mailing Address - Country:US
Mailing Address - Phone:847-756-7360
Mailing Address - Fax:847-462-1003
Practice Address - Street 1:509 W OLD NORTHWEST HWY
Practice Address - Street 2:SUITE 100C
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-6811
Practice Address - Country:US
Practice Address - Phone:847-756-7360
Practice Address - Fax:847-277-7191
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-02
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036095547207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036095547Medicaid
ILG51218Medicare UPIN
IL036095547Medicaid