=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295840841
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN J KASTRUP M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2006
-----------------------------------------------------
Last Update Date | 01/28/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1505 WIGWAM PKWY #330
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89074-8194
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-878-0393
-----------------------------------------------------
Fax | 702-933-0633
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7455 W WASHINGTON AVE STE 160
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89128-4356
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-878-0393
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207XS0114X
-----------------------------------------------------
Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 12909
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207XS0114X
-----------------------------------------------------
Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | MD041982L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------