Basic Information
| Provider Information | |||||||||
| NPI: | 1750383527 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DORGAN | ||||||||
| FirstName: | KATHLEEN | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 855 MADISON ST | ||||||||
| Address2: | |||||||||
| City: | OAK PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 603024420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083861000 | ||||||||
| FaxNumber: | 7083862394 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 ERIE CT | ||||||||
| Address2: | SUITE4120 | ||||||||
| City: | OAK PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 603022566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7085244576 | ||||||||
| FaxNumber: | 7085245073 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2005 | ||||||||
| LastUpdateDate: | 01/28/2008 | ||||||||
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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 | 207RN0300X | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 1616108 | 01 | IL | BCBS | OTHER |