MEDICARE: JOHN SCOTT KASTELER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	0104360A	IN
2	207N00000X	Dermatology Physician	61918	AZ

General Provider Information

NPI Number	:	1487659454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN SCOTT KASTELER M.D.

Provider Business Mailing Address
First Line	:	801 YORK ST
Second Line	:
City	:	MANITOWOC
State	:	WI
Zip	:	54220-4630
Country	:	US
Telephone Number	:	920-663-9008
Fax Number	:	920-684-1439

Provider Business Practice Location Address
First Line	:	875 N GREENFIELD RD STE 108
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85234-5044
Country	:	US
Telephone Number	:	480-801-2103
Fax Number	:	480-801-2104

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	09/20/2021

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