Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 01081337A | IN |
NPI | 1003286667 |
---|---|
Provider Name | Ceciley Starkey Casselman |
First Address | Indianapolis, IN 46202-2213 |
Second Address | Greencastle, IN 46135-2212 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2015 |
Last Update Date | 31/03/2021 |