Provider Demographics
NPI:1851358972
Name:KOOP, CATHERINE J (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:J
Last Name:KOOP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:
Other - Last Name:KOOP-DESIMONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:610 S. MAPLE
Mailing Address - Street 2:SUITE 4600
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304
Mailing Address - Country:US
Mailing Address - Phone:708-660-2240
Mailing Address - Fax:708-660-2243
Practice Address - Street 1:610 S. MAPLE
Practice Address - Street 2:SUITE 4600
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304
Practice Address - Country:US
Practice Address - Phone:708-660-2240
Practice Address - Fax:708-660-2243
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036096959207R00000X
IL036-096959207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036096959Medicaid
IL036096959Medicaid