MEDICARE: KRISTINA REGINA GASPERS PA-C

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	363A00000X	Physician Assistant	085003877	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01633203	OTHER	IL	BCBS GROUP
2	10115176	OTHER	IL	BCBS GROUP

General Provider Information

NPI Number	:	1093015448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA REGINA GASPERS PA-C

Provider Business Mailing Address
First Line	:	16519 S RTE 59
Second Line	:
City	:	PLAINFIELD
State	:	IL
Zip	:	60586-2606
Country	:	US
Telephone Number	:	630-646-5020
Fax Number	:	630-646-5025

Provider Business Practice Location Address
First Line	:	16519 S RTE 59
Second Line	:
City	:	PLAINFIELD
State	:	IL
Zip	:	60586-2606
Country	:	US
Telephone Number	:	630-646-5020
Fax Number	:	630-646-5025

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

Provider Enumeration Date	:	11/01/2010
Last Update Date	:	09/20/2016

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Directions to “ KRISTINA REGINA GASPERS PA-C” Practice Location

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