Healthcare Provider Details

I. General information

NPI: 1013940188
Provider Name (Legal Business Name): RACHAEL A KASPEROWICZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 05/15/2020
Certification Date: 05/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 W PIERSON RD
FLINT MI
48505-3348
US

IV. Provider business mailing address

30 W MONROE ST STE 1200
CHICAGO IL
60603-2420
US

V. Phone/Fax

Practice location:
  • Phone: 810-222-3033
  • Fax: 810-407-5729
Mailing address:
  • Phone: 312-733-9730
  • Fax: 773-886-8014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301080525
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: