Provider Demographics
NPI:1427057942
Name:KATCHEN, DEBRA (MD)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:KATCHEN
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 1:2 AMERICINN WAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:MONMOUTH
Mailing Address - State:IL
Mailing Address - Zip Code:61462-9415
Mailing Address - Country:US
Mailing Address - Phone:309-734-0100
Mailing Address - Fax:309-734-0200
Practice Address - Street 1:2 AMERICINN WAY
Practice Address - Street 2:SUITE B
Practice Address - City:MONMOUTH
Practice Address - State:IL
Practice Address - Zip Code:61462-9415
Practice Address - Country:US
Practice Address - Phone:309-734-0100
Practice Address - Fax:309-734-0200
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036078203207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036078203Medicaid
IL036078203Medicaid
IL209766Medicare ID - Type Unspecified