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NPI Code Detail

MEDICARE: K.A. JUCAS M.D., S.C.

MEDICARE: K.A. JUCAS M.D., S.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology Physician036044413IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2468361OTHERILMEDICARE ID

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
121609421OTHERILPROVIDER #

General Provider Information

NPI Number : 1144544305
Entity Type Code : Organization
Provider Name (Legal Business Name) : K.A. JUCAS M.D., S.C.
Provider Business Mailing Address
First Line : 3235 W 111TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60655-2730
Country : US
Telephone Number : 773-233-0744
Fax Number : 773-233-9416
Provider Business Practice Location Address
First Line : 3235 W 111TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60655-2730
Country : US
Telephone Number : 773-233-0744
Fax Number : 773-233-9416
Authorized Official
Title or Position : PRESIDENT
Name : DR. KASTYTIS A JUCAS
Credential : M.D.
Telephone Number : 773-233-0744
Provider Enumeration Date : 03/17/2010
Last Update Date : 03/17/2010

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1912004912 — DR. KATHLEEN CASPER D.O.
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1033285176 — BRADY'S PHARMACY
Practice Location Address:
3237 W 111TH ST
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60655-2730
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1205011822 — KATHLEEN CASPER, D.O., P.C.
Practice Location Address:
3235 W 111TH ST
CHICAGO, IL
60655-2730
Practice Phone: 773-445-2802
Practice Fax: 773-445-9983

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