Individual
DR. KATHLEEN MARIE DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
611 W PARK ST, URBANA, IL 61801-2529
(217) 383-3100
(217) 383-4468
Mailing address
611 W PARK ST, URBANA, IL 61801-2501
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
036146280
IL
2086S0102X
Surgical Critical Care Physician
036146280
IL
2086S0120X
Pediatric Surgery Physician
Primary
036146280
IL
2086S0120X
Pediatric Surgery Physician
57264
WI
Other
Enumeration date
03/06/2007
Last updated
10/21/2025
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