Basic Information
Provider Information
NPI: 1194987081
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HUMIKOWSKI
FirstName: CATHERINE
MiddleName: ANN
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 225 E CHICAGO AVE
Address2:  
City: CHICAGO
State: IL
PostalCode: 606112991
CountryCode: US
TelephoneNumber: 3122274000
FaxNumber: 7737024041
Practice Location
Address1: 225 E CHICAGO AVE
Address2:  
City: CHICAGO
State: IL
PostalCode: 606112991
CountryCode: US
TelephoneNumber: 3122274000
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/01/2008
LastUpdateDate: 05/14/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/14/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2080P0203X036123028ILY Allopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine

No ID Information.


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