Provider Demographics
NPI:1497840938
Name:KASPRIAK, FREDERICK JASON (PA-C)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:JASON
Last Name:KASPRIAK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8872 PROFESSIONAL DRIVE STE B
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-4960
Mailing Address - Country:US
Mailing Address - Phone:231-779-0320
Mailing Address - Fax:231-779-1367
Practice Address - Street 1:8872 PROFESSIONAL DRIVE STE B
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601
Practice Address - Country:US
Practice Address - Phone:231-779-0320
Practice Address - Fax:231-779-1367
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004894363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI383547536OtherCOMMERCIAL INSURANCES