Provider Demographics
NPI:1134221088
Name:KASTRUL, JEROME J (MD)
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:J
Last Name:KASTRUL
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 98978
Mailing Address - Street 2:#97
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-8978
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-216-3346
Practice Address - Street 1:13000 N 103RD AVE
Practice Address - Street 2:#97
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3060
Practice Address - Country:US
Practice Address - Phone:623-933-1337
Practice Address - Fax:623-933-6109
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2015-04-28
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Provider Licenses
StateLicense IDTaxonomies
AZ3752207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ173603Medicare PIN
AZC99737Medicare UPIN