Provider Demographics
NPI:1689468514
Name:KASTNER, LIAM RICHARD
Entity type:Individual
Prefix:
First Name:LIAM
Middle Name:RICHARD
Last Name:KASTNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 USS TRANQUILITY
Mailing Address - Street 2:3410 ILLINOS ST
Mailing Address - City:GREAT LAKES
Mailing Address - State:IL
Mailing Address - Zip Code:60088
Mailing Address - Country:US
Mailing Address - Phone:224-610-8553
Mailing Address - Fax:
Practice Address - Street 1:1007 USS TRANQUILITY
Practice Address - Street 2:3410 ILLINOS ST
Practice Address - City:GREAT LAKES
Practice Address - State:IL
Practice Address - Zip Code:60088
Practice Address - Country:US
Practice Address - Phone:224-610-8553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA7550246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other