Individual
RICHARD E KATHOLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
619 E MASON ST, SUITE 4P57, SPRINGFIELD, IL 62701-1034
(217) 788-0706
(217) 525-2535
Mailing address
PO BOX 19420, SPRINGFIELD, IL 62794-9420
(217) 788-0706
(217) 525-2535
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
036-073624
IL
207RC0000X
Cardiovascular Disease Physician
Primary
036073624
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036073624
—
IL
01
—
080009979
RAILROAD
IL
Enumeration date
10/19/2006
Last updated
12/28/2021
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