Provider Demographics
NPI:1669712808
Name:PAJAK, KATHRYN THERESA (MD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:THERESA
Last Name:PAJAK
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 1:16971 WESTPORT DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-4218
Mailing Address - Country:US
Mailing Address - Phone:714-398-7000
Mailing Address - Fax:
Practice Address - Street 1:5659 S OAK PARK AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-3227
Practice Address - Country:US
Practice Address - Phone:714-398-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036074045207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC50622Medicare UPIN