Provider Demographics
NPI:1366412504
Name:KUSS, JOHN A (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:KUSS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 S STAPLEY DR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-6681
Mailing Address - Country:US
Mailing Address - Phone:480-464-8500
Mailing Address - Fax:
Practice Address - Street 1:1840 S STAPLEY DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-6681
Practice Address - Country:US
Practice Address - Phone:480-464-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3480207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ486937Medicaid
AZ61195Medicare ID - Type Unspecified
AZ61193Medicare ID - Type Unspecified
AZ69941Medicare ID - Type Unspecified
AZ69953Medicare ID - Type Unspecified
AZ61194Medicare ID - Type Unspecified
AZ486937Medicaid