Provider Demographics
NPI:1942247770
Name:MORNO, KATHLEEN M (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:M
Last Name:MORNO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:KATHLEEN
Other - Middle Name:M
Other - Last Name:MORNO MOODY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9005 W CERMAK RD
Mailing Address - Street 2:
Mailing Address - City:NORTH RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546-1017
Mailing Address - Country:US
Mailing Address - Phone:708-442-8010
Mailing Address - Fax:708-442-8009
Practice Address - Street 1:9005 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:NORTH RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546-1017
Practice Address - Country:US
Practice Address - Phone:708-442-8010
Practice Address - Fax:708-442-8009
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036105394207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK23442Medicare ID - Type UnspecifiedMEMBER NUMBER
ILH54930Medicare UPIN