Provider Demographics
NPI:1669429510
Name:TREANOR, KATHLEEN MARY (MD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARY
Last Name:TREANOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:TREANOR-ARMICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:901 E SOUTHWIND RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-5125
Mailing Address - Country:US
Mailing Address - Phone:217-786-0093
Mailing Address - Fax:217-786-0193
Practice Address - Street 1:901 E SOUTHWIND RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-5125
Practice Address - Country:US
Practice Address - Phone:217-786-0093
Practice Address - Fax:217-786-0193
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036088510207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036088510Medicaid
ILG20949Medicare UPIN
IL209553Medicare ID - Type Unspecified