Provider Demographics
NPI:1780667584
Name:CASS, KATHLEEN ANN (MD PHD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANN
Last Name:CASS
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3006 S MARYLAND PKWY
Mailing Address - Street 2:SUITE 690 CHILDRENS HEART CENTER
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109
Mailing Address - Country:US
Mailing Address - Phone:702-732-1290
Mailing Address - Fax:702-732-1385
Practice Address - Street 1:3006 S MARYLAND PKWY
Practice Address - Street 2:SUITE #690
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109
Practice Address - Country:US
Practice Address - Phone:702-732-1290
Practice Address - Fax:702-732-1385
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV47932080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002002777Medicaid
NV4793OtherBLUE CROSS BLUE SHIELD
NVVWCLCQOtherMEDICARE GROUP #
XPY044330OtherMEDI-CAL
NV4793OtherBLUE CROSS BLUE SHIELD
C95865Medicare UPIN