Provider Demographics
NPI:1962408088
Name:CASSIS, TAMELLA BUSS (MD)
Entity type:Individual
Prefix:MRS
First Name:TAMELLA
Middle Name:BUSS
Last Name:CASSIS
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Gender:F
Credentials:MD
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Mailing Address - Street 1:9301 DAYFLOWER ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-7585
Mailing Address - Country:US
Mailing Address - Phone:502-326-8588
Mailing Address - Fax:502-326-8589
Practice Address - Street 1:9301 DAYFLOWER ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-7585
Practice Address - Country:US
Practice Address - Phone:502-326-8588
Practice Address - Fax:502-326-8589
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2011-02-17
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Provider Licenses
StateLicense IDTaxonomies
KY38026207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64102486Medicaid
KY64102486Medicaid
KY00569001Medicare PIN
I29321Medicare UPIN