Provider Demographics
NPI:1205116076
Name:TEFFT, KATHERINE DRIVER (PAC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:DRIVER
Last Name:TEFFT
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 N SHERIDAN RD
Mailing Address - Street 2:STE 101
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6156
Mailing Address - Country:US
Mailing Address - Phone:773-281-7835
Mailing Address - Fax:
Practice Address - Street 1:129 W 29TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5105
Practice Address - Country:US
Practice Address - Phone:415-658-6791
Practice Address - Fax:415-252-7176
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA5322363A00000X
CA52415363A00000X
NY018509363A00000X
IL085004071363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
212223002Medicare PIN