Provider Demographics
NPI:1588438139
Name:CASSIDAY, BRIAN
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:CASSIDAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 E BROADWAY AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4740
Mailing Address - Country:US
Mailing Address - Phone:701-415-6233
Mailing Address - Fax:833-525-1920
Practice Address - Street 1:425 MAIN ST S
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-4414
Practice Address - Country:US
Practice Address - Phone:701-415-6233
Practice Address - Fax:833-525-1920
Is Sole Proprietor?:No
Enumeration Date:2023-11-14
Last Update Date:2023-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist