Provider Demographics
NPI:1598718934
Name:CASSAS, KYLE JAMES (MD)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:JAMES
Last Name:CASSAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PT
Mailing Address - Street 2:SUITE 212
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4545
Mailing Address - Country:US
Mailing Address - Phone:864-797-6044
Mailing Address - Fax:
Practice Address - Street 1:200 PATEWOOD DR
Practice Address - Street 2:SUITE C 100
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3593
Practice Address - Country:US
Practice Address - Phone:864-454-7422
Practice Address - Fax:864-454-8265
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC27520207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00797627OtherRR MEDICARE
SCP00349204OtherRR MEDICARE
SC275204Medicaid
SCH30001Medicare UPIN
SCH300017951Medicare PIN
SCH300018299Medicare PIN
SC57-6007863158OtherBCBS OF SC
SC57-6007863133OtherBLUE CHOICE OF SC
SC7492152OtherAETNA
SCP00797627OtherRR MEDICARE