Basic Information
| Provider Information | |||||||||
| NPI: | 1073838629 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KASULKE | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | DAVID | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17 LANSING ST | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130211983 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3152531832 | ||||||||
| FaxNumber: | 3157028393 | ||||||||
| Practice Location | |||||||||
| Address1: | SURGICAL SERVICES OF AUBURN | ||||||||
| Address2: | 77 NELSON STREET, SUITE 320 | ||||||||
| City: | AUBURN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3152531832 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2010 | ||||||||
| LastUpdateDate: | 04/13/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 284157 | NY | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.