Healthcare Provider Details

I. General information

NPI: 1487659454
Provider Name (Legal Business Name): JOHN SCOTT KASTELER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: J SCOTT KASTELER M.D.

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 N GREENFIELD RD STE 108
GILBERT AZ
85234-5044
US

IV. Provider business mailing address

801 YORK ST
MANITOWOC WI
54220-4630
US

V. Phone/Fax

Practice location:
  • Phone: 480-801-2103
  • Fax: 480-801-2104
Mailing address:
  • Phone: 920-663-9008
  • Fax: 920-684-1439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0104360A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number61918
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: