Provider Demographics
NPI:1790886851
Name:SCARPULLA, KATHLEEN M (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:SCARPULLA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3115 N HARLEM AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-4683
Mailing Address - Country:US
Mailing Address - Phone:773-283-2454
Mailing Address - Fax:773-283-2474
Practice Address - Street 1:3115 N HARLEM AVE STE 300
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4683
Practice Address - Country:US
Practice Address - Phone:773-283-2454
Practice Address - Fax:773-283-2474
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2023-04-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036-075323207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-075323OtherSTATE LICENSE