Provider Demographics
NPI:1457364457
Name:DUMFORD, KATHLEEN E (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:E
Last Name:DUMFORD
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:BRIGHT LIGHT MEDICAL IMAGING
Mailing Address - Street 2:31 S. ARLINGTON HEIGHTS ROAD
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007
Mailing Address - Country:US
Mailing Address - Phone:847-439-2315
Mailing Address - Fax:847-439-3935
Practice Address - Street 1:31 S. ARLINGTON HEIGHTS ROAD
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007
Practice Address - Country:US
Practice Address - Phone:847-439-2315
Practice Address - Fax:847-439-3935
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-1069312085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
L93240Medicare ID - Type Unspecified
H32631Medicare UPIN