Provider Demographics
NPI:1194703819
Name:OCCHIPINTI, KATHRYN (MD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:OCCHIPINTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5212 N ROTHMERE DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-9302
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1770 IOWA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-2430
Practice Address - Country:US
Practice Address - Phone:309-231-3297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0993042085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL300097484OtherRAILROAD MEDICARE
ILIL0100OtherJOHN DEERE
IL0007222342OtherBLUE CROSS BLUE SHIELD
IL036099304-1Medicaid
IL3446903OtherACR
IL405209OtherHEALTHLINK
IL055131OtherHEALTH ALLIANCE
IL370947902OtherTRICARE CHAMPUS
ILIL0100OtherJOHN DEERE