Provider Demographics
NPI:1295840841
Name:KASTRUP, JOHN J (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:KASTRUP
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 1:7455 W WASHINGTON AVE
Mailing Address - Street 2:STE 160
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-4356
Mailing Address - Country:US
Mailing Address - Phone:702-878-0393
Mailing Address - Fax:
Practice Address - Street 1:1505 WIGWAM PKWY
Practice Address - Street 2:#330
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-8194
Practice Address - Country:US
Practice Address - Phone:702-878-0393
Practice Address - Fax:702-933-0633
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12909207XS0114X, 207XS0114X
PAMD041982L207XS0114X
FLME97165207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL68052OtherBCBS
FL279524800Medicaid
FLP00451374OtherRAILROAD MEDICARE
F82139Medicare UPIN
FL279524800Medicaid
BI024ZMedicare PIN
FLAB731ZMedicare PIN