Basic Information
| Provider Information | |||||||||
| NPI: | 1093771438 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KAGALWALLA | ||||||||
| FirstName: | YASMEEN | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6965 RELIABLE PARKWAY | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60686 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157407073 | ||||||||
| FaxNumber: | 8157404966 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 MAPLE RD | ||||||||
| Address2: | SILVER CROSS HOSPITAL | ||||||||
| City: | JOLIET | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157401100 | ||||||||
| FaxNumber: | 8157407901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | 036-094277 | IL | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 220026450 | 01 | IL | RR MC | OTHER | 0360942771 | 05 | IL | MEDICAID |