Basic Information
| Provider Information | |||||||||
| NPI: | 1790078764 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KUSTERER | ||||||||
| FirstName: | NATHAN | ||||||||
| MiddleName: | SCOTT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 230 LEXINGTON GREEN CIR STE 600 | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405033326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5989714658 | ||||||||
| FaxNumber: | 8599715460 | ||||||||
| Practice Location | |||||||||
| Address1: | 1720 NICHOLASVILLE RD STE 601 | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405031451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592775887 | ||||||||
| FaxNumber: | 8592767659 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2011 | ||||||||
| LastUpdateDate: | 12/07/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 47174 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 47174 | KY | N | Allopathic & Osteopathic Physicians | Hospitalist | 207RC0000X | 47174 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 7100265480 | 05 | KY | MEDICAID |