Provider Demographics
NPI:1932108503
Name:KASHA, EDWIN E (MD)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:E
Last Name:KASHA
Suffix:
Gender:M
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:PO BOX 15415
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47716-0415
Mailing Address - Country:US
Mailing Address - Phone:812-477-9495
Mailing Address - Fax:812-477-0134
Practice Address - Street 1:999 S KENMORE DR
Practice Address - Street 2:SUITE A
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-7514
Practice Address - Country:US
Practice Address - Phone:812-477-9495
Practice Address - Fax:812-477-0134
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01032814207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000108102OtherANTHEM PREFERRED ACCESS
IN000000526765OtherANTHEM
IN020007857OtherRAILROAD MEDICARE
IN35-1738788OtherFEDERAL TAX ID
IND70826Medicare UPIN
IN849320Medicare PIN