Provider Demographics
NPI:1790078764
Name:KUSTERER, NATHAN SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:SCOTT
Last Name:KUSTERER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:230 LEXINGTON GREEN CIR STE 600
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3326
Mailing Address - Country:US
Mailing Address - Phone:598-971-4658
Mailing Address - Fax:859-971-5460
Practice Address - Street 1:1720 NICHOLASVILLE RD STE 601
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1451
Practice Address - Country:US
Practice Address - Phone:859-277-5887
Practice Address - Fax:859-276-7659
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2020-12-07
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Provider Licenses
StateLicense IDTaxonomies
KY47174207R00000X, 208M00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100265480Medicaid