Provider Demographics
NPI:1225068240
Name:KASUFKIN, RICHARD A (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:KASUFKIN
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 1:7230 W NORTH AVE STE 106B
Mailing Address - Street 2:RESURRECTION IMMEDIATE CARE CENTER
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60707-4262
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7230 W NORTH AVE STE 106B
Practice Address - Street 2:RESURRECTION IMMEDIATE CARE CENTER
Practice Address - City:ELMWOOD PARK
Practice Address - State:IL
Practice Address - Zip Code:60707-4262
Practice Address - Country:US
Practice Address - Phone:708-453-3000
Practice Address - Fax:708-453-4660
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036103195207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3633309286030501Medicaid
IL036103195Medicaid
IL1619414OtherBCBS GROUP
IL3633309286030501Medicaid
IL036103195Medicaid
IL216966032Medicare PIN