Provider Demographics
NPI:1477537272
Name:KASPERSON, ELMER HAROLD (MD)
Entity Type:Individual
Prefix:DR
First Name:ELMER
Middle Name:HAROLD
Last Name:KASPERSON
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 1:1500 CURVE CREST BLVD W
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-6040
Mailing Address - Country:US
Mailing Address - Phone:651-439-1234
Mailing Address - Fax:651-439-1547
Practice Address - Street 1:1500 CURVE CREST BLVD W
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-6040
Practice Address - Country:US
Practice Address - Phone:651-439-1234
Practice Address - Fax:651-351-0827
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2011-12-06
Deactivation Date:2011-08-30
Deactivation Code:
Reactivation Date:2011-12-06
Provider Licenses
StateLicense IDTaxonomies
MN22178208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN186303700Medicaid
WI30282500Medicaid
MN020002095Medicare PIN
MND81302Medicare UPIN
P00215664Medicare PIN