Individual
KURT JOSEPH GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
215 S 1ST ST, LEHIGHTON, PA 18235-2163
(610) 377-5544
(610) 377-6744
Mailing address
215 S 1ST ST, LEHIGHTON, PA 18235-2163
(610) 377-5544
(610) 377-6744
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
SC004598L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0008247770003
—
PA
01
—
2811707
AETNA NO
PA
01
—
480033403
RAILROAD MEDICARE
PA
01
—
50000307
BLUE CROSS
PA
01
—
80426
GEISINGER
PA
01
—
815699
1ST PRIORITY
PA
Enumeration date
07/21/2006
Last updated
06/21/2011
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