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Organization

KAM MEDICAL LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KATRINA MATTINGLY MD (OWNER)
(352) 339-3111
Entity
Organization

Contact information

Practice address
1320 S PLYMOUTH CT, CHICAGO, IL 60605-2717
(352) 339-3111
Mailing address
PO BOX 7306, CAROL STREAM, IL 60197-7306
(352) 339-3111

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
261QE0002X
Emergency Care Clinic/Center
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
109814
AZ
01
F100783497
MEDICARE
IL
Enumeration date
07/23/2021
Last updated
08/25/2022
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