Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 21547 | CO |
NPI | 1093706475 |
---|---|
Provider Name | Dr. Stuart S Kassan |
First Address | Lakewood, CO 80228-2259 |
Second Address | Lakewood, CO 80228-2259 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2005 |
Last Update Date | 30/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01215474 | (05) | CO |
D23945 | (02) |