Healthcare Provider Details

I. General information

NPI: 1205011822
Provider Name (Legal Business Name): KATHLEEN CASPER, D.O., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 12/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3235 W 111TH ST
CHICAGO IL
60655-2730
US

IV. Provider business mailing address

10660 W 143RD ST SUITE B
ORLAND PARK IL
60462-1982
US

V. Phone/Fax

Practice location:
  • Phone: 773-445-2802
  • Fax: 773-445-9983
Mailing address:
  • Phone: 708-349-0055
  • Fax: 708-460-8031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036066773
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number036066773
License Number StateIL

VIII. Authorized Official

Name: KATHLEEN CASPER
Title or Position: OWNER
Credential: D.O.
Phone: 773-445-2802