MEDICARE: DR. JOHN ALOIS KUSTERMANN

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	207Q00000X	Family Medicine Physician	13753-20	WI

General Provider Information

NPI Number	:	1982057816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN ALOIS KUSTERMANN

Provider Business Mailing Address
First Line	:	490 CENTRAL AVENUE BLDG 281
Second Line	:	HONOLULU MILITARY ENTRANCE PROCESSING STATION
City	:	PEARL HARBOR
State	:	HI
Zip	:	96860
Country	:	US
Telephone Number	:	808-471-8725
Fax Number	:	808-474-8553

Provider Business Practice Location Address
First Line	:	490 CENTRAL AVENUE BLDG 281
Second Line	:	HONOLULU MILITARY ENTRANCE PROCESSING STATION
City	:	PEARL HARBOR
State	:	HI
Zip	:	96860
Country	:	US
Telephone Number	:	808-471-8725
Fax Number	:	808-474-8553

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

Provider Enumeration Date	:	07/15/2016
Last Update Date	:	07/15/2016

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