Provider Demographics
NPI:1982057816
Name:KUSTERMANN, JOHN ALOIS
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALOIS
Last Name:KUSTERMANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 CENTRAL AVENUE BLDG 281
Mailing Address - Street 2:HONOLULU MILITARY ENTRANCE PROCESSING STATION
Mailing Address - City:PEARL HARBOR
Mailing Address - State:HI
Mailing Address - Zip Code:96860
Mailing Address - Country:US
Mailing Address - Phone:808-471-8725
Mailing Address - Fax:808-474-8553
Practice Address - Street 1:490 CENTRAL AVENUE BLDG 281
Practice Address - Street 2:HONOLULU MILITARY ENTRANCE PROCESSING STATION
Practice Address - City:PEARL HARBOR
Practice Address - State:HI
Practice Address - Zip Code:96860
Practice Address - Country:US
Practice Address - Phone:808-471-8725
Practice Address - Fax:808-474-8553
Is Sole Proprietor?:No
Enumeration Date:2016-07-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13753-20207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine