Provider Demographics
NPI:1568789899
Name:KACZMAREK, JUSTINE MARIE
Entity Type:Individual
Prefix:MRS
First Name:JUSTINE
Middle Name:MARIE
Last Name:KACZMAREK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2194 ASHBY LN
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-5338
Mailing Address - Country:US
Mailing Address - Phone:815-609-3395
Mailing Address - Fax:
Practice Address - Street 1:2194 ASHBY LN
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60586-5338
Practice Address - Country:US
Practice Address - Phone:815-609-3395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist