Provider Demographics
NPI:1396031837
Name:PAPAK, CASSANDRA (DPM)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:PAPAK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 E DOUGLAS RD
Mailing Address - Street 2:STE 406
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-1464
Mailing Address - Country:US
Mailing Address - Phone:574-335-6500
Mailing Address - Fax:574-335-0772
Practice Address - Street 1:611 E DOUGLAS RD
Practice Address - Street 2:STE 406
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-1464
Practice Address - Country:US
Practice Address - Phone:574-335-6500
Practice Address - Fax:574-335-0772
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN41000254A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01517748Medicare PIN
ININ2015001Medicare PIN