Provider Demographics
NPI:1740491141
Name:WADE, KATHRYN KERR (MD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:KERR
Last Name:WADE
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:4969 BENCHMARK CENTRE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-8928
Mailing Address - Country:US
Mailing Address - Phone:618-235-2311
Mailing Address - Fax:618-589-3335
Practice Address - Street 1:4969 BENCHMARK CENTRE DR STE 100
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-8928
Practice Address - Country:US
Practice Address - Phone:618-235-2311
Practice Address - Fax:618-589-3335
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036147822208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1740491141Medicaid