Provider Demographics
NPI:1467439935
Name:KACMAR, JOSEPH A (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:A
Last Name:KACMAR
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 1:123 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:
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
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027088A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100158480AMedicaid
IN000000255544OtherBLUE SHIELD
INP00071826Medicare ID - Type UnspecifiedRAILRAOD MEDICARE
IN100158480AMedicaid
IN214030AMedicare ID - Type Unspecified