Basic Information
| Provider Information | |||||||||
| NPI: | 1679689988 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEGARTY | ||||||||
| FirstName: | KATHLEEN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2160 S FIRST AVE | ||||||||
| Address2: | 101-1740 LOYOLA UNIVERSITY MEDICAL CENTER | ||||||||
| City: | MAYWOOD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7082169000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2160 S FIRST AVE | ||||||||
| Address2: | 101-1740 LOYOLA UNIVERSITY MEDICAL CENTER | ||||||||
| City: | MAYWOOD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7082169000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 04/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 036116017 | IL | N | Allopathic & Osteopathic Physicians | Surgery | 207P00000X | 036116017 | IL | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.