Provider Demographics
NPI:1649591264
Name:CUMBERLAND PLATEAU GENERAL SURGERY, PLLC
Entity Type:Organization
Organization Name:CUMBERLAND PLATEAU GENERAL SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:KASTELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-881-3683
Mailing Address - Street 1:1589 SPARTA ST
Mailing Address - Street 2:STE 305
Mailing Address - City:MCMINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-1390
Mailing Address - Country:US
Mailing Address - Phone:931-507-5555
Mailing Address - Fax:931-507-5575
Practice Address - Street 1:1589 SPARTA ST
Practice Address - Street 2:STE 305
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-1390
Practice Address - Country:US
Practice Address - Phone:931-507-5555
Practice Address - Fax:931-507-5575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46154208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty