Provider Demographics
NPI:1457795569
Name:CASSIDY, LLOYD CHARLES IV (MD)
Entity Type:Individual
Prefix:DR
First Name:LLOYD
Middle Name:CHARLES
Last Name:CASSIDY
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:353 N DESPLAINES ST APT 607
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-1245
Mailing Address - Country:US
Mailing Address - Phone:847-502-2979
Mailing Address - Fax:
Practice Address - Street 1:124 SIEGLER ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-2636
Practice Address - Country:US
Practice Address - Phone:920-605-3115
Practice Address - Fax:920-486-6826
Is Sole Proprietor?:No
Enumeration Date:2013-04-18
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036144493207Q00000X
TXQ6620207Q00000X
WI70125207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine