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Dr. Katherine L Cassidy

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NPI Number Detailed Information

Provider Information:

Name: Dr. Katherine L Cassidy
Gender: F
Provider License Number If Given: 01054605A

NPI Information:

NPI: 1356336788
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 9/12/2005

Last Update Date: 5/11/2016

Provider Business Mailing Address:

Address: 3640 NEW VISION DRIVE SUITE A
Fort Wayne, IN 46845
Phone Number: 2604824440
Fax Number: 2604824442

Provider Business Practice Location Address:

Address: 2200 RANDALLIA DR
Fort Wayne, IN 46805
Phone Number: 2603734000
Fax Number: 2604824442

Provider Taxonomy:

Primary: 207P00000X
Secondary (if any):
State: IN

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