MEDICARE: CASANDRA L CANSLER M.D.

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	207R00000X	Internal Medicine Physician	28697	TN
2	208000000X	Pediatrics Physician	28697	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3150573	OTHER	TN	BLUECROSS BLUESHIELD TN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437153855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASANDRA L CANSLER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 301
Second Line	:
City	:	HIXSON
State	:	TN
Zip	:	37343-0301
Country	:	US
Telephone Number	:	423-332-8633
Fax Number	:	423-332-8634

Provider Business Practice Location Address
First Line	:	8804 DAYTON PIKE
Second Line	:	SUITE H
City	:	SODDY DAISY
State	:	TN
Zip	:	37379-4306
Country	:	US
Telephone Number	:	423-332-8633
Fax Number	:	423-332-8634

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	06/11/2010

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