Healthcare Provider Details

I. General information

NPI: 1215959069
Provider Name (Legal Business Name): MATTHEW KASSEL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 01/31/2022
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 POWDERHOUSE RD
CHEYENNE WY
82009-4800
US

IV. Provider business mailing address

5050 POWDERHOUSE RD
CHEYENNE WY
82009-4800
US

V. Phone/Fax

Practice location:
  • Phone: 307-634-1311
  • Fax: 307-634-1271
Mailing address:
  • Phone: 307-634-1311
  • Fax: 307-634-1271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number42147
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: