Provider Demographics
NPI:1619004645
Name:CASSELL, LINDA L
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:L
Last Name:CASSELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6857 S FRANKLIN CIR
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-1321
Mailing Address - Country:US
Mailing Address - Phone:303-794-8920
Mailing Address - Fax:
Practice Address - Street 1:5257 S WADSWORTH BLVD
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-2228
Practice Address - Country:US
Practice Address - Phone:303-972-8084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO78308207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
015408OtherKAISER-COMMERCIAL NUMBER