Provider Demographics
NPI:1053714576
Name:FINNEKE, KATHLEEN A (PA-C)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:FINNEKE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:A
Other - Last Name:GEORGIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:6216 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:ROSEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60018-4323
Mailing Address - Country:US
Mailing Address - Phone:920-265-5763
Mailing Address - Fax:
Practice Address - Street 1:2073 N CLYBOURN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-4003
Practice Address - Country:US
Practice Address - Phone:773-665-4016
Practice Address - Fax:773-360-6200
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-29
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085005260363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical