Provider Demographics
NPI:1144544305
Name:K.A. JUCAS M.D., S.C.
Entity type:Organization
Organization Name:K.A. JUCAS M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KASTYTIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:JUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-233-0744
Mailing Address - Street 1:3235 W 111TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655-2730
Mailing Address - Country:US
Mailing Address - Phone:773-233-0744
Mailing Address - Fax:773-233-9416
Practice Address - Street 1:3235 W 111TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-2730
Practice Address - Country:US
Practice Address - Phone:773-233-0744
Practice Address - Fax:773-233-9416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036044413207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21609421OtherPROVIDER #
IL468361OtherMEDICARE ID
IL21609421OtherPROVIDER #