Provider Demographics
NPI:1447266564
Name:KATCHEN, MARC (MD)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:KATCHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 N KELLOGG ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-2875
Mailing Address - Country:US
Mailing Address - Phone:309-342-7002
Mailing Address - Fax:309-342-3257
Practice Address - Street 1:765 N KELLOGG ST
Practice Address - Street 2:SUITE 207
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-2875
Practice Address - Country:US
Practice Address - Phone:309-342-7002
Practice Address - Fax:309-342-3257
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360782822084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7215059OtherBCBS PPO
IL0360782822Medicaid
IL061658OtherHEALTH ALLIANCE
IL130022365OtherRAILROAD MEDICARE
IL472298OtherHEALTHLINK
ILIL01H4OtherJOHN DEERE
IL7215059OtherBCBS PPO
IL0360782822Medicaid