Provider Demographics
NPI:1912004912
Name:CASPER, KATHLEEN (DO)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:CASPER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10660 W 143RD ST STE B
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-1989
Mailing Address - Country:US
Mailing Address - Phone:708-349-0055
Mailing Address - Fax:708-460-8031
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:773-445-2802
Practice Address - Fax:773-445-9983
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036066773207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036066773Medicaid
IL712650Medicare ID - Type UnspecifiedMEDICARE
IL036066773Medicaid