Provider Demographics
NPI:1295129310
Name:BAUBLY, KATHRYN
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:BAUBLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 N HAVEN RD FL 2
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2973
Mailing Address - Country:US
Mailing Address - Phone:630-595-9988
Mailing Address - Fax:331-225-2296
Practice Address - Street 1:103 N HAVEN RD FL 2
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2973
Practice Address - Country:US
Practice Address - Phone:630-595-9988
Practice Address - Fax:331-225-2296
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036146055207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine