Provider Demographics
NPI:1295171023
Name:PAINTER, KATHERINE C (MD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:C
Last Name:PAINTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:C
Other - Last Name:STRACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:513 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:IL
Mailing Address - Zip Code:62906-1697
Mailing Address - Country:US
Mailing Address - Phone:618-833-4471
Mailing Address - Fax:618-833-4900
Practice Address - Street 1:513 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:IL
Practice Address - Zip Code:62906-1668
Practice Address - Country:US
Practice Address - Phone:618-833-4471
Practice Address - Fax:618-833-4900
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0054685207Q00000X
IL036148565207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01655454OtherRAILROAD MEDICARE WITH CEDAR POINT HEALTH
CO498620YTYKOtherWITH CEDAR POINT HEALTH
CO26958350Medicaid