Provider Demographics
NPI:1760434450
Name:KASTAN, DAVID J (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:KASTAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2799 W GRAND BLVD
Mailing Address - Street 2:HENRY FORD DEPT. OF RADIOLOGY
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2608
Mailing Address - Country:US
Mailing Address - Phone:313-916-7425
Mailing Address - Fax:313-916-7925
Practice Address - Street 1:2799 W GRAND BLVD
Practice Address - Street 2:HENRY FORD DEPT. OF RADIOLOGY
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:313-916-7425
Practice Address - Fax:313-916-7925
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2009-11-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI43010469942085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4112382Medicaid
MIOH16003043Medicare ID - Type Unspecified
MIA79422Medicare UPIN