Healthcare Provider Details

I. General information

NPI: 1528298411
Provider Name (Legal Business Name): KELLY CASSERLY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2009
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7250 METRO BLVD STE 100
EDINA MN
55439-2145
US

IV. Provider business mailing address

7250 METRO BLVD STE 100
EDINA MN
55439-2145
US

V. Phone/Fax

Practice location:
  • Phone: 612-778-6240
  • Fax:
Mailing address:
  • Phone: 612-778-6240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number57705
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number57705
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: