Healthcare Provider Details

I. General information

NPI: 1558359703
Provider Name (Legal Business Name): ELDON E CASSELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 06/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 W GREEN ST
HASTINGS MI
49058-1710
US

IV. Provider business mailing address

PO BOX 74
HASTINGS MI
49058-0074
US

V. Phone/Fax

Practice location:
  • Phone: 269-945-3451
  • Fax:
Mailing address:
  • Phone: 800-678-1861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number4301042020
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: