Provider Demographics
NPI:1639842933
Name:KASS, CONSTANCE PATRICIA
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:PATRICIA
Last Name:KASS
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 1:9760 S KEDZIE AVE
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-3109
Mailing Address - Country:US
Mailing Address - Phone:708-423-8150
Mailing Address - Fax:708-423-8152
Practice Address - Street 1:9760 S KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-3109
Practice Address - Country:US
Practice Address - Phone:708-423-8150
Practice Address - Fax:708-423-8152
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-01
Last Update Date:2023-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085008654363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical