Provider Demographics
NPI:1639172026
Name:KASTE, SUE C (DO)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:C
Last Name:KASTE
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 1:262 DANNY THOMAS PL
Mailing Address - Street 2:MS 515
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-3678
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:262 DANNY THOMAS PL
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-3678
Practice Address - Country:US
Practice Address - Phone:901-595-3006
Practice Address - Fax:901-595-3842
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN008422085P0229X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO245081906Medicaid
LA1429708Medicaid
IN200179710AMedicaid
GA296551509AMedicaid
NC7612098Medicaid
MT0071927Medicaid
IA0528844Medicaid
ME422400000Medicaid
KY64926835Medicaid
AL009914340Medicaid
KS100448940AMedicaid
AR132316003Medicaid
CO75557312Medicaid
MS00125789Medicaid
MI104812540Medicaid
AZ579146Medicaid
TN3303933Medicaid
LA1429708Medicaid
IN200179710AMedicaid