Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 036-2646215 | IL |
NPI | 1013923689 |
---|---|
Provider Name | Dr. Kathleen Oshea-Wilk |
First Address | Hazel Crest, IL 60429-2184 |
Second Address | Hazel Crest, IL 60429-2184 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 10/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F08656 | (02) | IL |