Provider Demographics
NPI:1750468591
Name:JELINEK, KATHERINE (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:JELINEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 RANDALL RD
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4209
Mailing Address - Country:US
Mailing Address - Phone:630-262-7400
Mailing Address - Fax:630-262-3760
Practice Address - Street 1:302 RANDALL RD
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4209
Practice Address - Country:US
Practice Address - Phone:630-262-7400
Practice Address - Fax:630-262-3760
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-108039207RG0100X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP01308433OtherMEDICARE RR (INDIVIDUAL)
IL036108039Medicaid
ILF400122269OtherMEDICARE PTAN (INDIVIDUAL)
ILCA4748OtherMEDICARE RR (GROUP)
IL206147OtherMEDICARE PTAN (GROUP)