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General NPI Number Information
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NPI Number | 1144428103
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Entity Type | Individual
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Provider Name | DANIEL S. KASSAVIN MD
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Gender | Male
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 08/19/2019
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Provider Practice Location Address
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Address Line | MEDINA MEDICAL OFFICE BUILDING / SOUTH 970 E WASHINGTON ST STE 4B
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City | MEDINA
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State | OH
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Zip | 44256-2181
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Country | US
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Telephone | 330-721-5700
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Fax | 330-721-5287
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Provider Business Mailing Address
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Address Line | 2330 EUCLID HEIGHTS BLVD APT 306
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City | CLEVELAND
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State | OH
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Zip | 44106-2728
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Country | US
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Telephone | 716-704-3301
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 35.127258
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License Number State | OH
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