=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013220573
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SCOTT C KASTNING PA-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2010
-----------------------------------------------------
Last Update Date | 09/06/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 302 W CHESTNUT ST
-----------------------------------------------------
City | BRECKENRIDGE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48615-9579
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-842-3118
-----------------------------------------------------
Fax | 989-843-3118
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 302 W CHESTNUT ST
-----------------------------------------------------
City | BRECKENRIDGE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48615-9579
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-842-3118
-----------------------------------------------------
Fax | 989-842-1110
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------