Provider Demographics
NPI:1326049792
Name:CASSAVAR, DANIEL K (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:K
Last Name:CASSAVAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 BRIGHAM DR STE 120
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-7121
Mailing Address - Country:US
Mailing Address - Phone:419-872-7703
Mailing Address - Fax:419-872-1704
Practice Address - Street 1:1601 BRIGHAM DR STE 120
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-7121
Practice Address - Country:US
Practice Address - Phone:419-872-7703
Practice Address - Fax:419-872-1704
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.064640207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0920025Medicaid
MI4680746Medicaid
OH25-01205OtherUHC
MI4680737Medicaid
OH02052OtherPARAMOUNT
OH000000285788OtherANTHEM
OHP00038304OtherRRMC
OH4334400OtherAETNA
MI4680755Medicaid
OH4334400OtherAETNA
OHP00038304OtherRRMC
OH25-01205OtherUHC