Provider Demographics
NPI:1538456462
Name:CASSELMAN, JASON EVAN (DO)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:EVAN
Last Name:CASSELMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1100 REID PKWY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-966-1600
Mailing Address - Fax:765-962-9641
Practice Address - Street 1:1434 CHESTER BLVD
Practice Address - Street 2:REID ENT
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1947
Practice Address - Country:US
Practice Address - Phone:765-966-9600
Practice Address - Fax:765-962-9641
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101019322207R00000X
OH34.011409207RA0201X
IN02004839A207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000001014850OtherANTHEM
OH0172513Medicaid
IN201359200Medicaid
OH0172513Medicaid
IN201359200Medicaid