Provider Demographics
NPI:1285620484
Name:KASKEL, LARRY SAMUEL (MD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:SAMUEL
Last Name:KASKEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2101 WAUKEGAN RD STE 303
Mailing Address - Street 2:
Mailing Address - City:BANNOCKBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60015-1836
Mailing Address - Country:US
Mailing Address - Phone:847-530-5851
Mailing Address - Fax:
Practice Address - Street 1:2101 WAUKEGAN RD STE 303
Practice Address - Street 2:
Practice Address - City:BANNOCKBURN
Practice Address - State:IL
Practice Address - Zip Code:60015-1836
Practice Address - Country:US
Practice Address - Phone:847-595-4838
Practice Address - Fax:224-487-4963
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36081103207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE-49121Medicare UPIN