Provider Demographics
NPI:1801938642
Name:MICHAEL G. CASSARO, MD, PSC
Entity type:Organization
Organization Name:MICHAEL G. CASSARO, MD, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:VELTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-207-2092
Mailing Address - Street 1:200 MISSOURI AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130
Mailing Address - Country:US
Mailing Address - Phone:812-207-2092
Mailing Address - Fax:812-284-5083
Practice Address - Street 1:200 MISSOURI AVE
Practice Address - Street 2:SUITE B
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3061
Practice Address - Country:US
Practice Address - Phone:812-207-2092
Practice Address - Fax:812-284-5083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY22779208VP0014X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000317233OtherANTHEM PIN
KY000000317233OtherANTHEM PIN