Organization
K.A. JUCAS M.D., S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KASTYTIS A JUCAS M.D. (PRESIDENT)
(773) 233-0744
Entity
Organization
Contact information
Practice address
3235 W 111TH ST, CHICAGO, IL 60655-2730
(773) 233-0744
(773) 233-9416
Mailing address
3235 W 111TH ST, CHICAGO, IL 60655-2730
(773) 233-0744
(773) 233-9416
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
036044413
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21609421
PROVIDER #
IL
01
—
468361
MEDICARE ID
IL
Enumeration date
03/17/2010
Last updated
03/17/2010
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