Healthcare Provider Details

I. General information

NPI: 1538801469
Provider Name (Legal Business Name): KEVIN THOMAS KUUSKVERE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2375 E PRATER WAY
SPARKS NV
89434-9641
US

IV. Provider business mailing address

85 S 32ND ST
BOULDER CO
80305-3487
US

V. Phone/Fax

Practice location:
  • Phone: 954-939-5000
  • Fax:
Mailing address:
  • Phone: 704-907-5029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20A22261
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDO3949
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: