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NPI Code Detail

MEDICARE: DR. KASTYTIS ALEXANDER JUCAS M.D.

MEDICARE: DR. KASTYTIS ALEXANDER JUCAS M.D.
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
1207N00000XDermatology Physician036-044413IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
121609421OTHERILPROVIDER #

General Provider Information

NPI Number : 1609876952
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KASTYTIS ALEXANDER JUCAS M.D.
Provider Business Mailing Address
First Line : 3235 W 111TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60655-2730
Country : US
Telephone Number : 773-233-0744
Fax Number : 773-233-9416
Provider Business Practice Location Address
First Line : 3235 W 111TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60655-2730
Country : US
Telephone Number : 773-233-0744
Fax Number : 773-233-9416
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2005
Last Update Date : 07/08/2007

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