Provider Demographics
NPI:1184925463
Name:C A CATELLANI M D S C
Entity type:Organization
Organization Name:C A CATELLANI M D S C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CATELLANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-673-5300
Mailing Address - Street 1:7830 KILBOURN AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-3512
Mailing Address - Country:US
Mailing Address - Phone:847-673-5300
Mailing Address - Fax:847-673-7063
Practice Address - Street 1:7830 KILBOURN AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-3512
Practice Address - Country:US
Practice Address - Phone:847-673-5300
Practice Address - Fax:847-673-7063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036057626207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC44787Medicare UPIN