Provider Demographics
NPI:1477735397
Name:EMMERICH, KATE MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:KATE
Middle Name:MARIE
Last Name:EMMERICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:WILKENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20733 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:CARLINVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62626-3710
Mailing Address - Country:US
Mailing Address - Phone:217-854-3141
Mailing Address - Fax:
Practice Address - Street 1:20613 N BROAD ST STE B
Practice Address - Street 2:
Practice Address - City:CARLINVILLE
Practice Address - State:IL
Practice Address - Zip Code:62626-3721
Practice Address - Country:US
Practice Address - Phone:217-854-3881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.125395207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine