Provider Demographics
NPI:1487659454
Name:KASTELER, JOHN SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:SCOTT
Last Name:KASTELER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:J
Other - Middle Name:SCOTT
Other - Last Name:KASTELER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:875 N GREENFIELD RD STE 108
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-5044
Practice Address - Country:US
Practice Address - Phone:480-801-2103
Practice Address - Fax:480-801-2104
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0104360A207N00000X
AZ61918207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64289168Medicaid
KY0381303Medicare PIN
IN200044800AMedicaid
INM400064580Medicare PIN
070007686OtherRR MEDICARE
INP01145929OtherIN-RR MEDICARE
F46346Medicare UPIN