Provider Demographics
NPI:1518967371
Name:CASNELLIE, MICHAEL THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:THOMAS
Last Name:CASNELLIE
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 1:3615 NEWBURG RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-3368
Mailing Address - Country:US
Mailing Address - Phone:502-583-1011
Mailing Address - Fax:855-859-0123
Practice Address - Street 1:9300 STONESTREET RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40272-2863
Practice Address - Country:US
Practice Address - Phone:502-935-8061
Practice Address - Fax:502-933-7010
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39494207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50040105OtherPASSPORT HEALTH-NORTON LEATHERMAN SPINE
KY2448515000OtherPASSPORT ADVANTAGE
KY771665OtherANTHEM- NORTON LEATHERMAN SPINE
KYP00314315OtherRAILROAD MEDICARE
KYK046980OtherMEDICARE- NORTON LEATHERMAN SPINE
KY0343740001OtherMEDICARE DME GRP #
KY50007360OtherPASSPORT
KY64104706Medicaid
KY50040105OtherPASSPORT HEALTH-NORTON LEATHERMAN SPINE
KY771665OtherANTHEM- NORTON LEATHERMAN SPINE
KY50040105OtherPASSPORT HEALTH-NORTON LEATHERMAN SPINE