Provider Demographics
NPI:1891856100
Name:KASUKONIS, JR., JOHN EDWARD (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:EDWARD
Last Name:KASUKONIS, JR.
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 315
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-0315
Mailing Address - Country:US
Mailing Address - Phone:907-260-3524
Mailing Address - Fax:
Practice Address - Street 1:245 N BINKLEY ST STE 202
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7500
Practice Address - Country:US
Practice Address - Phone:907-714-4521
Practice Address - Fax:907-714-4699
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2025-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175T00000X
AK2467207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMEDO2467OtherPROFESSIONAL LICENSE