Provider Demographics
NPI:1457349722
Name:CASSARO, MICHAEL G (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:G
Last Name:CASSARO
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 6924
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-0924
Mailing Address - Country:US
Mailing Address - Phone:812-207-2092
Mailing Address - Fax:812-284-5083
Practice Address - Street 1:601 N SHORE DR
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130
Practice Address - Country:US
Practice Address - Phone:812-207-2092
Practice Address - Fax:812-284-5083
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01053504A208VP0014X, 207LP2900X
KY22779208VP0014X
LA06295R208VP0014X
FLME90486208VP0014X
HI8073208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000317233OtherANTHEM
0908101Medicare ID - Type Unspecified
000000317233OtherANTHEM