Provider Demographics
NPI:1295728194
Name:KASIMOS, JOHN NICHOLAS (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:NICHOLAS
Last Name:KASIMOS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:113 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-3301
Mailing Address - Country:US
Mailing Address - Phone:219-873-3130
Mailing Address - Fax:219-873-3132
Practice Address - Street 1:20201 CRAWFORD AVE
Practice Address - Street 2:ST JAMES HOSPITAL OLYMPIA FIELDS CAMPUS
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1010
Practice Address - Country:US
Practice Address - Phone:708-747-4000
Practice Address - Fax:708-503-3242
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01630255OtherBC/BS
E18430Medicare UPIN
ILP00095651Medicare PIN
ILL97069Medicare PIN