1457381808 NPI number — DR. V DANIEL KASSICIEH D.O.

Table of content: DR. V DANIEL KASSICIEH D.O. (NPI 1457381808)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457381808 NPI number — DR. V DANIEL KASSICIEH D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KASSICIEH
Provider First Name:
V
Provider Middle Name:
DANIEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457381808
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3501 CATTLEMEN RD
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
SARASOTA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34232-6055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-955-5858
Provider Business Mailing Address Fax Number:
941-955-0044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3501 CATTLEMEN RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SARASOTA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34232-6055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-955-5858
Provider Business Practice Location Address Fax Number:
941-955-0044
Provider Enumeration Date:
07/03/2006

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: 2084N0400X , with the licence number:  OS-5188 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9278126 . This is a "CIGNA ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0501068 . This is a "UNITED HEALTHCARE ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 82939 . This is a "BLUE CROSS ID NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2878649 . This is a "AETNA ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 59298 . This is a "EMI PROVIDER ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 00025 . This is a "UNIVERSAL HEALTH CARE ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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