Provider Demographics
NPI:1891779328
Name:KARSTAEDT, PATRICIA J (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:J
Last Name:KARSTAEDT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 E SUPERIOR ST
Mailing Address - Street 2:LYNN SAGE BREAST CENTER, 4TH FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2914
Mailing Address - Country:US
Mailing Address - Phone:312-472-0436
Mailing Address - Fax:
Practice Address - Street 1:250 E SUPERIOR ST
Practice Address - Street 2:LYNN SAGE BREAST CENTER, 4TH FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2914
Practice Address - Country:US
Practice Address - Phone:312-472-0436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361225932085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ86080015085260A040OtherTRIWEST
AZ300077586OtherRR MEDICARE
AZ389694Medicaid
AZ86080015085259A369OtherTRIWEST
G54017Medicare UPIN
AZZ20167Medicare PIN