Healthcare Provider Details

I. General information

NPI: 1093767584
Provider Name (Legal Business Name): DAVID J KASS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CAMPUS DR
HANCOCK MI
49930-1569
US

IV. Provider business mailing address

301 EXPLORER ST
GWINN MI
49841-2813
US

V. Phone/Fax

Practice location:
  • Phone: 906-483-1060
  • Fax: 906-483-1071
Mailing address:
  • Phone: 906-346-4924
  • Fax: 906-346-6474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMI43060048
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: