Provider Demographics
NPI:1649411869
Name:KASPRZAK,PRINCE & DHARLA, LLC
Entity Type:Organization
Organization Name:KASPRZAK,PRINCE & DHARLA, LLC
Other - Org Name:HEALTHCHEK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:K
Authorized Official - Last Name:KASPRZAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-322-7041
Mailing Address - Street 1:2141 INDIANAPOLIS BLVD.
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-2805
Mailing Address - Country:US
Mailing Address - Phone:219-322-7041
Mailing Address - Fax:219-322-8918
Practice Address - Street 1:2141 INDIANAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-2805
Practice Address - Country:US
Practice Address - Phone:219-322-7041
Practice Address - Fax:219-322-8918
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KASPRZAK, PRINCE & DHARLA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336019925252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211676Medicare PIN