Provider Demographics
NPI:1821295528
Name:KITSTEINER, JOHN MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MARK
Last Name:KITSTEINER
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:LAJES FIELD 65 MDG/SGOP
Mailing Address - Street 2:UNIT 7745
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09720-7745
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:LAJES FIELD 65 MDG/SGOP
Practice Address - Street 2:UNIT 7745
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09720-7745
Practice Address - Country:US
Practice Address - Phone:314-535-3239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-15226207Q00000X
TN51453207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine