Individual
DR. JASON EVAN CASSELMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1434 CHESTER BLVD, REID ENT, RICHMOND, IN 47374-1947
(765) 966-9600
(765) 962-9641
Mailing address
1100 REID PKWY, MEDICAL STAFF SERVICES, RICHMOND, IN 47374-1157
(765) 966-1600
(765) 962-9641
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
5101019322
MI
207RA0201X
Allergy & Immunology (Internal Medicine) Physician
Primary
02004839A
IN
207RA0201X
Allergy & Immunology (Internal Medicine) Physician
34.011409
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001014850
ANTHEM
—
05
—
0172513
—
OH
05
—
201359200
—
IN
Enumeration date
06/29/2011
Last updated
05/12/2021
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