Provider Demographics
NPI:1053518589
Name:KAKASCIK, AIMEE GRETCHEN (DO)
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:GRETCHEN
Last Name:KAKASCIK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6621 FANNIN ST STE 310
Mailing Address - Street 2:MC 2-1495
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2303
Mailing Address - Country:US
Mailing Address - Phone:832-824-5900
Mailing Address - Fax:832-825-5905
Practice Address - Street 1:6621 FANNIN ST STE 310
Practice Address - Street 2:MC 2-1495
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2303
Practice Address - Country:US
Practice Address - Phone:832-824-5900
Practice Address - Fax:832-825-5905
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9392207LP3000X
MS19731207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MST1650OtherMEDICAL LICENSE NUMBER