Individual
KATHERINE ANNE WIDERBORG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1537 FORT JESSE RD, SUITE A, NORMAL, IL 61761
(309) 808-0122
(309) 808-0552
Mailing address
1505 EASTLAND DR, SUITE 2300, BLOOMINGTON, IL 61701-3534
(309) 662-9022
(309) 662-2091
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036-068927
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0360689271
—
IL
Enumeration date
10/02/2006
Last updated
03/12/2013
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