Provider Demographics
NPI:1083656581
Name:KASPER, LAWRENCE MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:MICHAEL
Last Name:KASPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006
Mailing Address - Country:US
Mailing Address - Phone:602-521-3700
Mailing Address - Fax:602-521-3701
Practice Address - Street 1:1441 N 12TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006
Practice Address - Country:US
Practice Address - Phone:602-521-3700
Practice Address - Fax:602-521-3701
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19354207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ104430Medicaid
AZF20044Medicare UPIN
AZZ11WCHDS04Medicare PIN