Healthcare Provider Details

I. General information

NPI: 1902485378
Provider Name (Legal Business Name): PAIGE ALANA CASSIDY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 MICHIGAN ST NE FL 2
GRAND RAPIDS MI
49503-2514
US

IV. Provider business mailing address

35 MICHIGAN ST NE FL 2
GRAND RAPIDS MI
49503-2514
US

V. Phone/Fax

Practice location:
  • Phone: 616-267-1925
  • Fax: 616-267-9430
Mailing address:
  • Phone: 616-267-1925
  • Fax: 616-267-9430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301514817
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number4301514817
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301514817
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: