Provider Demographics
NPI:1669496550
Name:MATHES, KATHLEEN D (DPM)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:D
Last Name:MATHES
Suffix:
Gender:F
Credentials:DPM
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Mailing Address - Street 1:15931 S BELL RD
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-6707
Mailing Address - Country:US
Mailing Address - Phone:708-301-3080
Mailing Address - Fax:708-301-6198
Practice Address - Street 1:5331 W 79TH ST
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-3500
Practice Address - Country:US
Practice Address - Phone:708-636-4022
Practice Address - Fax:708-636-4105
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2021-01-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL016002942213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0876900001Medicare NSC