| Bruce A. Cassidy, D.O., PC | |
|
28080 Grand River Ave Ste 208n Farmington Hills MI 48336-5966 | |
| (248) 308-2604 | |
| (248) 308-2608 |
| Full Name | Bruce A. Cassidy, D.O., PC |
|---|---|
| Speciality | Internal Medicine |
| Location | 28080 Grand River Ave Ste 208n, Farmington Hills, Michigan |
| Authorized Official Name and Position | Michelle Mcgee (OFFICE MANAGER) |
| Authorized Official Contact | 2483082604 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bruce A. Cassidy, D.O., PC Po Box 673102 Detroit MI 48267-3102 Ph: (248) 308-2604 | Bruce A. Cassidy, D.O., PC 28080 Grand River Ave Ste 208n Farmington Hills MI 48336-5966 Ph: (248) 308-2604 |
| NPI Number | 1053409268 |
|---|---|
| Provider Enumeration Date | 10/11/2006 |
| Last Update Date | 09/19/2022 |
| Certification Date | 09/19/2022 |
| Medicare PECOS PAC ID | 6709869365 |
|---|---|
| Medicare Enrollment ID | O20040612000597 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053409268 | NPI | - | NPPES |
| 1156307745 | Other | MI | BCBS |
| 114334390 | Medicaid | MI | |
| 1770568198 | Other | MI | INDIVIDUAL NPI |
| BC013348 | Other | MI | MI STATE LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | BC013348 (Michigan) | Secondary |
| 207R00000X | Internal Medicine | () | Primary |
| Provider Name | Bruce a Cassidy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770568198 PECOS PAC ID: 1052394616 Enrollment ID: I20040616001040 |
| Provider Name | Katherine Rae Holyfield |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447786207 PECOS PAC ID: 6507126083 Enrollment ID: I20180131002431 |
| Provider Name | Danielle Marie Saunders |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114420528 PECOS PAC ID: 9931459112 Enrollment ID: I20180910001220 |
| Provider Name | Suraya Ezzat Chamseddine |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285378422 PECOS PAC ID: 1951786177 Enrollment ID: I20220923000806 |
| Provider Name | Kimberly Ann Buatti |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316660145 PECOS PAC ID: 4284092701 Enrollment ID: I20230615000953 |
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