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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 |
