1689152068 NPI number — DR. TODD JAMES CASON DO

Table of content: DR. TODD JAMES CASON DO (NPI 1689152068)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689152068 NPI number — DR. TODD JAMES CASON DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASON
Provider First Name:
TODD
Provider Middle Name:
JAMES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CASON
Provider Other First Name:
TIMOTHY
Provider Other Middle Name:
JAMES
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689152068
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 249
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT ATKINSON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53538-0249
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-563-4466
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2825 HUNTERS TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTAGE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53901-3429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-742-7161
Provider Business Practice Location Address Fax Number:
608-745-3990
Provider Enumeration Date:
07/30/2018

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 75686-21 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1689152068 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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