Basic Information
| Provider Information | |||||||||
| NPI: | 1235122706 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HALLERAN | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | O. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 E HURON ST APT 1707 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606115900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153371953 | ||||||||
| FaxNumber: | 6303218750 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 E FAIRMAN AVE | ||||||||
| Address2: | |||||||||
| City: | WATSEKA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 609701644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6303218300 | ||||||||
| FaxNumber: | 6303218750 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207P00000X | IL | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.