Provider Demographics
NPI:1356388342
Name:CASSIDY, JOHN MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:CASSIDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6151 S YALE AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-1907
Mailing Address - Country:US
Mailing Address - Phone:918-494-8500
Mailing Address - Fax:918-307-5586
Practice Address - Street 1:6151 S YALE AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-1907
Practice Address - Country:US
Practice Address - Phone:918-494-8500
Practice Address - Fax:918-307-5586
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2008-03-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK18361207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP00409612OtherRAILROAD MEDICARE
OKC 78423Medicare UPIN