MEDICARE: CONNOR KASIK

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	207X00000X	Orthopaedic Surgery Physician	036.149387	IL
2	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	036149387	IL

General Provider Information

NPI Number	:	1851631592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONNOR KASIK

Provider Business Mailing Address
First Line	:	920 WEST ST STE 211
Second Line	:
City	:	PERU
State	:	IL
Zip	:	61354-2769
Country	:	US
Telephone Number	:	815-223-2143
Fax Number	:

Provider Business Practice Location Address
First Line	:	920 WEST ST STE 211
Second Line	:
City	:	PERU
State	:	IL
Zip	:	61354-2769
Country	:	US
Telephone Number	:	815-223-2143
Fax Number	:	815-223-7443

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

Provider Enumeration Date	:	02/17/2013
Last Update Date	:	11/17/2023

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Directions to “ CONNOR KASIK ” Practice Location

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