Healthcare Provider Details

I. General information

NPI: 1891770780
Provider Name (Legal Business Name): WILLIAM R KASTEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3421 W 9TH ST
WATERLOO IA
50702-5401
US

IV. Provider business mailing address

PO BOX 2910
WATERLOO IA
50704-2910
US

V. Phone/Fax

Practice location:
  • Phone: 319-272-8000
  • Fax: 319-233-0722
Mailing address:
  • Phone: 319-233-3044
  • Fax: 319-233-0722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number25389
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: