Provider Demographics
NPI:1356370233
Name:CRETICOS, CATHERINE M (MD)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:M
Last Name:CRETICOS
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 1:777 OAKMONT LN
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5511
Mailing Address - Country:US
Mailing Address - Phone:630-789-2550
Mailing Address - Fax:
Practice Address - Street 1:836 W WELLINGTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5147
Practice Address - Country:US
Practice Address - Phone:773-296-7039
Practice Address - Fax:773-296-7909
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036065043207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL20362183501OtherADVOCATE HLTH CENTERS ID
IL01635822OtherBCBS PROVIDER ID
IL036065043Medicaid
IL141016OtherADVOCATE HLTH PARTNERS ID
ILP00426755OtherRAILROAD MEDICARE
IL141016OtherADVOCATE HLTH PARTNERS ID
IL036065043Medicaid