Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 4301089308 | MI |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 4301089308 | MI |
NPI | 1316919798 |
---|---|
Provider Name | Jeffrey A Cassidy |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Grand Rapids, MI 49503-2027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2006 |
Last Update Date | 22/02/2021 |