Provider Demographics
NPI:1942304456
Name:DORONILA-HUGHES, KATERINA C (MD)
Entity Type:Individual
Prefix:DR
First Name:KATERINA
Middle Name:C
Last Name:DORONILA-HUGHES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATERINA
Other - Middle Name:C
Other - Last Name:DORONILA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1200 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61102-2112
Mailing Address - Country:US
Mailing Address - Phone:815-490-1600
Mailing Address - Fax:815-490-1881
Practice Address - Street 1:1200 W STATE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61102-2112
Practice Address - Country:US
Practice Address - Phone:815-490-1600
Practice Address - Fax:815-490-1881
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036116843207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036116843OtherILLINOIS LICENSE
IL336077935OtherILLINOIS CONTROLLED SUB
IL834340026OtherMEDICARE INDIVIDUAL PTAN
IL553180038OtherMEDICARE INDIVIDUAL PTAN
IL834340OtherMEDICARE GROUP PTAN
IL553180OtherMEDICARE GROUP PTAN