Provider Demographics
NPI:1457381808
Name:KASSICIEH, V DANIEL (DO)
Entity Type:Individual
Prefix:DR
First Name:V
Middle Name:DANIEL
Last Name:KASSICIEH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 CATTLEMEN RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6055
Mailing Address - Country:US
Mailing Address - Phone:941-955-5858
Mailing Address - Fax:941-955-0044
Practice Address - Street 1:3501 CATTLEMEN RD
Practice Address - Street 2:SUITE B
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6055
Practice Address - Country:US
Practice Address - Phone:941-955-5858
Practice Address - Fax:941-955-0044
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS-51882084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9278126OtherCIGNA ID
FL0501068OtherUNITED HEALTHCARE ID
FL82939OtherBLUE CROSS ID NUMBER
FL2878649OtherAETNA ID
FL59298OtherEMI PROVIDER ID
FL00025OtherUNIVERSAL HEALTH CARE ID
FL59298OtherEMI PROVIDER ID
FL82939OtherBLUE CROSS ID NUMBER