Provider Demographics
NPI:1013220573
Name:KASTNING, SCOTT C (PA-C)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:C
Last Name:KASTNING
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 W CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48615-9579
Mailing Address - Country:US
Mailing Address - Phone:989-842-3118
Mailing Address - Fax:989-842-1110
Practice Address - Street 1:302 W CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:MI
Practice Address - Zip Code:48615-9579
Practice Address - Country:US
Practice Address - Phone:989-842-3118
Practice Address - Fax:989-843-3118
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5601005830OtherPA LICENSE
MI1063846OtherMCLAREN
MI1063847OtherMCLAREN
MI0852900280OtherBCBSM
MIM17400041Medicare PIN