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NPI Code Detail

MEDICARE: MRS. TAMELLA BUSS CASSIS MD

MEDICARE: MRS. TAMELLA BUSS CASSIS 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
1207N00000XDermatology Physician38026KY

Other Identifiers

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

General Provider Information

NPI Number : 1962408088
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TAMELLA BUSS CASSIS MD
Provider Business Mailing Address
First Line : 9301 DAYFLOWER ST
Second Line : SUITE 100
City : PROSPECT
State : KY
Zip : 40059-7585
Country : US
Telephone Number : 502-326-8588
Fax Number : 502-326-8589
Provider Business Practice Location Address
First Line : 9301 DAYFLOWER ST
Second Line : SUITE 100
City : PROSPECT
State : KY
Zip : 40059-7585
Country : US
Telephone Number : 502-326-8588
Fax Number : 502-326-8589
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2005
Last Update Date : 02/17/2011

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