Provider Demographics
NPI:1699095828
Name:WHEATLEY, CATHERINE NICOLE (MD)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:NICOLE
Last Name:WHEATLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:CATHERINE
Other - Middle Name:NICOLE
Other - Last Name:BARTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:820 S WOOD ST # MC808
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4325
Mailing Address - Country:US
Mailing Address - Phone:312-996-7430
Mailing Address - Fax:
Practice Address - Street 1:1801 W TAYLOR ST # MC650
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-413-7500
Practice Address - Fax:312-413-3856
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036142692207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM04838793Medicaid
TX342237003Medicaid
TX342237001Medicaid
OK200570970 AMedicaid
NM04838793Medicaid