Provider Demographics
NPI:1356552954
Name:BRENNAN, KATHLEEN BURKE (PA)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:BURKE
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2650 RIDGE AVE
Mailing Address - Street 2:EVANSTON HOSPITAL
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1718
Mailing Address - Country:US
Mailing Address - Phone:847-570-1206
Mailing Address - Fax:847-570-1248
Practice Address - Street 1:2100 PFINGSTEN RD
Practice Address - Street 2:DEPARTMENT OF NEUROLOGY, SUITE 3000
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1301
Practice Address - Country:US
Practice Address - Phone:847-503-4342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-001499363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP38017Medicare UPIN