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General NPI Number Information
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NPI Number | 1053409268
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Entity Type | Organization
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Legal Business Name | BRUCE A. CASSIDY, D.O., PC
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 09/19/2022
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Provider Practice Location Address
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Address Line | 28080 GRAND RIVER AVE STE 208N
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City | FARMINGTON HILLS
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State | MI
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Zip | 48336-5966
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Country | US
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Telephone | 248-308-2604
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Fax | 248-308-2608
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Provider Business Mailing Address
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Address Line | PO BOX 673102
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City | DETROIT
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State | MI
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Zip | 48267-3102
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Country | US
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Telephone | 248-308-2604
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Fax | 248-308-2608
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. MICHELLE MCGEE
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Credential |
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Telephone | 248-308-2604
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | BC013348
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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