Healthcare Provider Details

I. General information

NPI: 1891856100
Provider Name (Legal Business Name): JOHN EDWARD KASUKONIS, JR. D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 05/04/2025
Certification Date: 05/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 N BINKLEY ST STE 202
SOLDOTNA AK
99669-7500
US

IV. Provider business mailing address

PO BOX 315
SOLDOTNA AK
99669-0315
US

V. Phone/Fax

Practice location:
  • Phone: 907-714-4521
  • Fax: 907-714-4699
Mailing address:
  • Phone: 907-260-3524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2467
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: