Provider Demographics
NPI:1336108307
Name:KASS, DAVID G (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:G
Last Name:KASS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10 TOWER DR
Mailing Address - Street 2:DEAN MEDICAL CENTER
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-1239
Mailing Address - Country:US
Mailing Address - Phone:608-825-3008
Mailing Address - Fax:608-825-3786
Practice Address - Street 1:10 TOWER DR
Practice Address - Street 2:DEAN MEDICAL CENTER
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-1239
Practice Address - Country:US
Practice Address - Phone:608-825-3008
Practice Address - Fax:608-825-3786
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI48765207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1336108307Medicaid
WIP00432253OtherRAILROAD MEDICARE
WI43544000Medicaid
WIP00432253Medicare PIN
WI741501716Medicare PIN
WI60689OtherDEAN HEALTH INSURANCE