Individual
KATHLEEN ELIZABETH DETWILER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD, MD
Contact information
Practice address
2160 S 1ST AVE, LUH NORTH ENTRANCE, NUCLEAR MEDICINE, MAYWOOD, IL 60153-3328
(708) 202-7000
(708) 216-6890
Mailing address
248 E QUINCY ST, RIVERSIDE, IL 60546-2178
(630) 202-4852
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
XXXXXXXXXXXXXXXX
IL
2085N0904X
Nuclear Radiology Physician
125061472
IL
Other
Enumeration date
04/11/2012
Last updated
07/21/2020
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