Provider Demographics
NPI:1609968759
Name:KASSAY, KARA MICHELE (MD)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:MICHELE
Last Name:KASSAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12511 SW 68TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8510
Mailing Address - Country:US
Mailing Address - Phone:503-675-1137
Mailing Address - Fax:503-534-1137
Practice Address - Street 1:12511 SW 68TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-8298
Practice Address - Country:US
Practice Address - Phone:503-675-1137
Practice Address - Fax:503-534-1137
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD21729207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR288213Medicaid
OR288213Medicaid
112454Medicare ID - Type Unspecified