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General NPI Number Information
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NPI Number | 1518967371
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Entity Type | Individual
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Provider Name | MICHAEL THOMAS CASNELLIE M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/22/2005
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Last Update Date | 07/29/2021
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Provider Practice Location Address
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Address Line | 9300 STONESTREET RD
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City | LOUISVILLE
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State | KY
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Zip | 40272-2863
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Country | US
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Telephone | 502-935-8061
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Fax | 502-933-7010
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Provider Business Mailing Address
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Address Line | 3615 NEWBURG RD
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City | LOUISVILLE
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State | KY
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Zip | 40218-3368
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Country | US
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Telephone | 502-583-1011
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Fax | 855-859-0123
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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 | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | 39494
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License Number State | KY
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