Healthcare Provider Details

I. General information

NPI: 1841889912
Provider Name (Legal Business Name): MICHAEL JUSTIN KASPER PARAMEDIC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2021
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 2ND AVE SW
CEDAR RAPIDS IA
52404-2003
US

IV. Provider business mailing address

9701 ANGLE RD
FAIRFAX IA
52228-9769
US

V. Phone/Fax

Practice location:
  • Phone: 319-892-6100
  • Fax:
Mailing address:
  • Phone: 319-721-3425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberPM-21-007-11
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierPM-21-007-11
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerIOWA DEPARTMENT OF PUBLIC HEALTH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: