MEDICARE: MICHELLE L KASSEL

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	209033851	IL

General Provider Information

NPI Number	:	1639039738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE L KASSEL

Provider Business Mailing Address
First Line	:	40 E 9TH ST
Second Line	:	APT 1303
City	:	CHICAGO
State	:	IL
Zip	:	60605
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 E 9TH ST APT 1303
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-2148
Country	:	US
Telephone Number	:	224-678-2392
Fax Number	:

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

Provider Enumeration Date	:	11/12/2025
Last Update Date	:	11/12/2025

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