Provider Demographics
NPI:1962400051
Name:CASSEL, KATHLEEN M (MD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:CASSEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1600 WEEOT WAY
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-4734
Mailing Address - Country:US
Mailing Address - Phone:707-825-5010
Mailing Address - Fax:707-825-6736
Practice Address - Street 1:241 SALMON AVE
Practice Address - Street 2:
Practice Address - City:KLAMATH
Practice Address - State:CA
Practice Address - Zip Code:95548
Practice Address - Country:US
Practice Address - Phone:707-482-2181
Practice Address - Fax:707-482-3655
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70180207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A701800Medicaid
CAH56852Medicare UPIN
CA00A701800Medicaid