Provider Demographics
NPI:1972779007
Name:RASCHKA, KATHLEEN B (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:B
Last Name:RASCHKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 N FRONTAGE RD
Mailing Address - Street 2:IMMEDIATE CARE
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-7819
Mailing Address - Country:US
Mailing Address - Phone:708-327-1064
Mailing Address - Fax:
Practice Address - Street 1:6800 N FRONTAGE RD
Practice Address - Street 2:IMMEDIATE CARE
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-7819
Practice Address - Country:US
Practice Address - Phone:708-327-1064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036122217207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL201015001Medicare PIN