Provider Demographics
NPI:1609876952
Name:JUCAS, KASTYTIS ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:KASTYTIS
Middle Name:ALEXANDER
Last Name:JUCAS
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 1:3235 W 111TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655-2730
Mailing Address - Country:US
Mailing Address - Phone:773-233-0744
Mailing Address - Fax:773-233-9416
Practice Address - Street 1:3235 W 111TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-2730
Practice Address - Country:US
Practice Address - Phone:773-233-0744
Practice Address - Fax:773-233-9416
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-044413207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21609421OtherPROVIDER #
IL072910052Medicare ID - Type UnspecifiedRAILROAD PROVIDER #
ILC41744Medicare UPIN
IL468361Medicare ID - Type UnspecifiedPROVIDER #