Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 5101019322 | MI |
N | 111NI0900X | Internist | 5101019322 | MI |
Y | 207RA0201X | Internist - Allergy & Immunology | 02004839A | IN |
N | 207RA0201X | Internist - Allergy & Immunology | 34.011409 | OH |
NPI | 1538456462 |
---|---|
Provider Name | Dr. Jason Evan Casselman |
First Address | Richmond, IN 47374-1157 |
Second Address | Richmond, IN 47374-1947 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2011 |
Last Update Date | 12/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000001014850 | ANTHEM (01) | |
0172513 | (05) | OH |
201359200 | (05) | IN |