1568508513 NPI number — MARY STEWART CASSADY PH.D.

Table of content: MARY STEWART CASSADY PH.D. (NPI 1568508513)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568508513 NPI number — MARY STEWART CASSADY PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASSADY
Provider First Name:
MARY
Provider Middle Name:
STEWART
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SPILMAN
Provider Other First Name:
MARY
Provider Other Middle Name:
STEWART
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1568508513
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
36873 MORAVIAN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLINTON TWP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48035-1211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-214-8425
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11111 HALL RD
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
UTICA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48317-5711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-254-7383
Provider Business Practice Location Address Fax Number:
586-254-7383
Provider Enumeration Date:
01/29/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC2200X , with the licence number:  6301012228 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 6301012228 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)