MEDICARE: CASANDRA L. CANSLER, MD, PC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	G84991	OTHER		UPIN

General Provider Information

NPI Number	:	1669597357
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASANDRA L. CANSLER, MD, PC

Provider Business Mailing Address
First Line	:	PO BOX 11443
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37401-2443
Country	:	US
Telephone Number	:	423-332-8633
Fax Number	:	423-332-8634

Provider Business Practice Location Address
First Line	:	8804 DAYTON PIKE
Second Line	:
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	:	SOLE PROPRIETOR
Name	:	CASANDRA L CANSLER
Credential	:	MD
Telephone Number	:	423-332-8634

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	09/23/2008

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