Provider Demographics
NPI:1518092972
Name:CASSARA, MICHELLE KAREN (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:KAREN
Last Name:CASSARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3555 LUTHERAN PKWY
Mailing Address - Street 2:SUITE 180
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6021
Mailing Address - Country:US
Mailing Address - Phone:303-403-7933
Mailing Address - Fax:303-403-7945
Practice Address - Street 1:3555 LUTHERAN PKWY
Practice Address - Street 2:SUITE 180
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6021
Practice Address - Country:US
Practice Address - Phone:303-403-7933
Practice Address - Fax:303-403-7945
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO46410207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO69820244Medicaid
CO69820244Medicaid
NC14928UMedicare UPIN