Provider Demographics
NPI:1780636720
Name:PAPAZIAN, KATHLEEN I (DO)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:I
Last Name:PAPAZIAN
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 1:1213 NORWOOD ST.
Mailing Address - Street 2:EMERGENCY DEPARTMENT
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160
Mailing Address - Country:US
Mailing Address - Phone:312-636-1903
Mailing Address - Fax:
Practice Address - Street 1:4201 W MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-8409
Practice Address - Country:US
Practice Address - Phone:815-759-3100
Practice Address - Fax:815-363-9044
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200500232207P00000X
FLOS18744207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901020Medicaid
IL036093024OtherSTATE LICENSE
NC13975OtherBLUE CROSS
NCP00205633OtherRAILROAD MEDICARE
NCG39097Medicare UPIN
NCP00205633OtherRAILROAD MEDICARE
NC2402419Medicare ID - Type Unspecified