Provider Demographics
NPI:1760590194
Name:ROSENFELD, KATIE ELIZABETH (DO)
Entity type:Individual
Prefix:DR
First Name:KATIE
Middle Name:ELIZABETH
Last Name:ROSENFELD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MRS
Other - First Name:KATIE
Other - Middle Name:ELIZABETH
Other - Last Name:KEAGLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:875 N MICHIGAN AVE FL 31
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-1962
Mailing Address - Country:US
Mailing Address - Phone:855-237-7546
Mailing Address - Fax:
Practice Address - Street 1:875 N MICHIGAN AVE FL 31
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-1962
Practice Address - Country:US
Practice Address - Phone:855-237-7546
Practice Address - Fax:773-446-2670
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-110227207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILI15126Medicare UPIN