MEDICARE: DR. PATRICIA J KARSTAEDT M.D.

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
1	2085R0202X	Diagnostic Radiology Physician	036122593	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	300077586	OTHER	AZ	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	86080015085260A040	OTHER	AZ	TRIWEST
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	86080015085259A369	OTHER	AZ	TRIWEST

General Provider Information

NPI Number	:	1891779328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA J KARSTAEDT M.D.

Provider Business Mailing Address
First Line	:	250 E SUPERIOR ST
Second Line	:	LYNN SAGE BREAST CENTER, 4TH FLOOR
City	:	CHICAGO
State	:	IL
Zip	:	60611-2914
Country	:	US
Telephone Number	:	312-472-0436
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 E SUPERIOR ST
Second Line	:	LYNN SAGE BREAST CENTER, 4TH FLOOR
City	:	CHICAGO
State	:	IL
Zip	:	60611-2914
Country	:	US
Telephone Number	:	312-472-0436
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	10/28/2011

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