Basic Information
| Provider Information | |||||||||
| NPI: | 1073004222 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASSIDY-WESCOTT | ||||||||
| FirstName: | KYLE | ||||||||
| MiddleName: | ALAN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 HAWKINS DR | ||||||||
| Address2: | |||||||||
| City: | IOWA CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 522421009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3194677888 | ||||||||
| FaxNumber: | 3196787399 | ||||||||
| Practice Location | |||||||||
| Address1: | 1765 LININGER LN | ||||||||
| Address2: | |||||||||
| City: | NORTH LIBERTY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 523172335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3194677888 | ||||||||
| FaxNumber: | 3194677399 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2018 | ||||||||
| LastUpdateDate: | 08/29/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD-48731 | IA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.