Provider Demographics
NPI:1285648253
Name:JOSEPH A. KACMAR, M.D., P.C.
Entity Type:Organization
Organization Name:JOSEPH A. KACMAR, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:KACMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-663-0815
Mailing Address - Street 1:123 N COURT ST
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-3931
Mailing Address - Country:US
Mailing Address - Phone:219-663-0815
Mailing Address - Fax:219-663-7310
Practice Address - Street 1:123 N COURT ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-3931
Practice Address - Country:US
Practice Address - Phone:219-663-0815
Practice Address - Fax:219-663-7310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN214030Medicare ID - Type Unspecified