Individual
COLLEEN F CASSIDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
130 CORPORATE DR, BEAVER DAM, WI 53916-3116
(920) 887-3102
(920) 855-8790
Mailing address
130 CORPORATE DR, BEAVER DAM, WI 53916-3116
(920) 887-3102
(920) 855-8790
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
61855-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1275899841
—
WI
Enumeration date
04/07/2012
Last updated
03/01/2021
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