Basic Information
| Provider Information | |||||||||
| NPI: | 1013940188 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KASPEROWICZ | ||||||||
| FirstName: | RACHAEL | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30 W MONROE ST STE 1200 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606032420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3127339730 | ||||||||
| FaxNumber: | 7738868014 | ||||||||
| Practice Location | |||||||||
| Address1: | 102 W PIERSON RD | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485053348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102223033 | ||||||||
| FaxNumber: | 8104075729 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 05/15/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301080525 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 080D410020 | 01 | MI | BCBS COMM BLUE BCN CHOICE | OTHER | 1020377 | 01 | MI | MHP HAN | OTHER | CD3610 PO0357906 | 01 | MI | METRAHEALTH | OTHER | 4882008 | 05 | MI | MEDICAID | 01003115 | 01 | MI | HEALTH PLUS | OTHER | 17649 | 01 | MI | MCARE | OTHER |