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General NPI Number Information
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NPI Number | 1891856100
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Entity Type | Individual
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Provider Name | JOHN EDWARD KASUKONIS, JR. D.O.
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Gender | Male
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 05/04/2025
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Provider Practice Location Address
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Address Line | 245 N BINKLEY ST STE 202
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City | SOLDOTNA
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State | AK
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Zip | 99669-7500
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Country | US
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Telephone | 907-714-4521
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Fax | 907-714-4699
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Provider Business Mailing Address
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Address Line | PO BOX 315
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City | SOLDOTNA
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State | AK
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Zip | 99669-0315
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Country | US
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Telephone | 907-260-3524
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 2467
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License Number State | AK
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