MEDICARE: DANIEL S. KASSAVIN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician	35.127258	OH

General Provider Information

NPI Number	:	1144428103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL S. KASSAVIN MD

Provider Business Mailing Address
First Line	:	2330 EUCLID HEIGHTS BLVD
Second Line	:	APT 306
City	:	CLEVELAND
State	:	OH
Zip	:	44106-2728
Country	:	US
Telephone Number	:	716-704-3301
Fax Number	:

Provider Business Practice Location Address
First Line	:	MEDINA MEDICAL OFFICE BUILDING / SOUTH
Second Line	:	970 E WASHINGTON ST STE 4B
City	:	MEDINA
State	:	OH
Zip	:	44256-2181
Country	:	US
Telephone Number	:	330-721-5700
Fax Number	:	330-721-5287

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2007
Last Update Date	:	08/19/2019

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