Healthcare Provider Details

I. General information

NPI: 1144861733
Provider Name (Legal Business Name): CASSEN GATES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2019
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 WASHINGTON AVE
BAY CITY MI
48708
US

IV. Provider business mailing address

443 N STATE ST
CARO MI
48723-1539
US

V. Phone/Fax

Practice location:
  • Phone: 989-684-7977
  • Fax:
Mailing address:
  • Phone: 989-672-6160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401017862
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: