Provider Demographics
NPI:1073956694
Name:DUCASTEL, JONATHAN AARON (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:AARON
Last Name:DUCASTEL
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 1:3537 W FRONT ST STE A
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-7942
Mailing Address - Country:US
Mailing Address - Phone:231-935-0338
Mailing Address - Fax:231-258-7555
Practice Address - Street 1:3537 W FRONT ST STE A
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-7942
Practice Address - Country:US
Practice Address - Phone:231-935-0338
Practice Address - Fax:231-258-7555
Is Sole Proprietor?:No
Enumeration Date:2013-04-12
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301112263207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1073956694Medicaid