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General NPI Number Information
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NPI Number | 1609876952
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Entity Type | Individual
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Provider Name | KASTYTIS ALEXANDER JUCAS M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/28/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3235 W 111TH ST
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City | CHICAGO
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State | IL
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Zip | 60655-2730
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Country | US
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Telephone | 773-233-0744
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Fax | 773-233-9416
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Provider Business Mailing Address
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Address Line | 3235 W 111TH ST
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City | CHICAGO
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State | IL
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Zip | 60655-2730
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Country | US
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Telephone | 773-233-0744
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Fax | 773-233-9416
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 036-044413
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License Number State | IL
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