Healthcare Provider Details

I. General information

NPI: 1932697745
Provider Name (Legal Business Name): CASSANDRA NICOLE DISHMAN-KESSLER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CASSANDRA DISHMAN

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 S ROGERS ST
BLOOMINGTON IN
47403-4752
US

IV. Provider business mailing address

250 N SHADELAND AVE
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 812-353-3700
  • Fax: 812-353-5859
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102206677
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02006724A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: