Healthcare Provider Details

I. General information

NPI: 1235296559
Provider Name (Legal Business Name): STEPHEN H KASSEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 VALLEY CHILDRENS PL
MADERA CA
93638-8761
US

IV. Provider business mailing address

968 E WIMBLEDON DR
FRESNO CA
93720-1355
US

V. Phone/Fax

Practice location:
  • Phone: 559-353-6103
  • Fax:
Mailing address:
  • Phone: 559-353-6103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0213X
TaxonomyPediatric Pathology Physician
License NumberG18364
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: