Provider Demographics
NPI:1205011822
Name:KATHLEEN CASPER, D.O., P.C.
Entity Type:Organization
Organization Name:KATHLEEN CASPER, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CASPER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:773-445-2802
Mailing Address - Street 1:10660 W 143RD ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-1982
Mailing Address - Country:US
Mailing Address - Phone:708-349-0055
Mailing Address - Fax:708-460-8031
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:773-445-2802
Practice Address - Fax:773-445-9983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036066773207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0031600471OtherBLUE CROSS BLUE SHIELD
ILCB1617OtherPALMETTO RR MEDICARE
IL216179Medicare PIN