Provider Demographics
NPI:1942496435
Name:REZEK, KATHRYN
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:
Last Name:REZEK
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:REZEK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:636 CHURCH ST
Mailing Address - Street 2:STE. 718
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4508
Mailing Address - Country:US
Mailing Address - Phone:184-732-8141
Mailing Address - Fax:184-732-8845
Practice Address - Street 1:636 CHURCH ST
Practice Address - Street 2:STE. 718
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4508
Practice Address - Country:US
Practice Address - Phone:184-732-8141
Practice Address - Fax:184-732-8845
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019020674122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist