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NPI Code Detail

MEDICARE: KATHLEEN CASPER, D.O., P.C.

MEDICARE: KATHLEEN CASPER, D.O., P.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
1207RG0300XGeriatric Medicine (Internal Medicine) Physician036066773IL
2207R00000XInternal Medicine Physician036066773IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2CB1617OTHERILPALMETTO RR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10031600471OTHERILBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1205011822
Entity Type Code : Organization
Provider Name (Legal Business Name) : KATHLEEN CASPER, D.O., P.C.
Provider Business Mailing Address
First Line : 10660 W 143RD ST
Second Line : SUITE B
City : ORLAND PARK
State : IL
Zip : 60462-1982
Country : US
Telephone Number : 708-349-0055
Fax Number : 708-460-8031
Provider Business Practice Location Address
First Line : 3235 W 111TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60655-2730
Country : US
Telephone Number : 773-445-2802
Fax Number : 773-445-9983
Authorized Official
Title or Position : OWNER
Name : KATHLEEN CASPER
Credential : D.O.
Telephone Number : 773-445-2802
Provider Enumeration Date : 01/02/2008
Last Update Date : 12/03/2008

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