Provider Demographics
NPI:1770607483
Name:KASCHAK, THOMAS JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOSEPH
Last Name:KASCHAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3983 S. MCCARRAN BLVD., #232
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-7510
Mailing Address - Country:US
Mailing Address - Phone:702-490-6950
Mailing Address - Fax:559-473-4544
Practice Address - Street 1:1700 COFFEE ROAD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355
Practice Address - Country:US
Practice Address - Phone:209-521-8490
Practice Address - Fax:209-521-8103
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG67586207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G675861Medicaid
E54098Medicare UPIN
CA00G675861Medicaid