MEDICARE: MICHAEL THOMAS CASNELLIE 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	207XS0117X	Orthopaedic Surgery of the Spine Physician	39494	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00314315	OTHER	KY	RAILROAD MEDICARE
5	K046980	OTHER	KY	MEDICARE- NORTON LEATHERMAN SPINE
6	0343740001	OTHER	KY	MEDICARE DME GRP #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50040105	OTHER	KY	PASSPORT HEALTH-NORTON LEATHERMAN SPINE
2	2448515000	OTHER	KY	PASSPORT ADVANTAGE
3	771665	OTHER	KY	ANTHEM- NORTON LEATHERMAN SPINE
7	50007360	OTHER	KY	PASSPORT
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518967371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL THOMAS CASNELLIE M.D.

Provider Business Mailing Address
First Line	:	3615 NEWBURG RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40218-3368
Country	:	US
Telephone Number	:	502-583-1011
Fax Number	:	855-859-0123

Provider Business Practice Location Address
First Line	:	9300 STONESTREET RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40272-2863
Country	:	US
Telephone Number	:	502-935-8061
Fax Number	:	502-933-7010

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

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	07/29/2021

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Directions to “ MICHAEL THOMAS CASNELLIE M.D.” Practice Location

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