Provider Demographics
NPI:1811916505
Name:CASSETTA, MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:CASSETTA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:15 CORPORATE DR
Mailing Address - Street 2:SUITE 2-1
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-1351
Mailing Address - Country:US
Mailing Address - Phone:203-452-2446
Mailing Address - Fax:203-452-2424
Practice Address - Street 1:15 CORPORATE DR
Practice Address - Street 2:SUITE 2-1
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-1351
Practice Address - Country:US
Practice Address - Phone:203-452-2446
Practice Address - Fax:203-452-2424
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT042092207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT3560058OtherAETNA
CTP3187877OtherOXFORD HEALTH PLANS
CT042092OtherCONNECTICARE, INC & AFFIL
CTCV8755OtherHEALTHNET
CT040042092CT01OtherANTHEM BLUE CROSS BLUE SH
CT4233361OtherCIGNA HEALTHCARE OF CT
CTP00250757OtherRAILROAD MEDICARE PTAN
CT040042092CT01OtherANTHEM BLUE CROSS BLUE SH