Basic Information
| Provider Information | |||||||||
| NPI: | 1265448526 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KASE, SPEELMAN, &CULLEN, M.D.'S, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 970 E WASHINGTON ST | ||||||||
| Address2: | STE 4B | ||||||||
| City: | MEDINA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442563332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307233256 | ||||||||
| FaxNumber: | 3307226731 | ||||||||
| Practice Location | |||||||||
| Address1: | 970 E WASHINGTON ST | ||||||||
| Address2: | STE 4B | ||||||||
| City: | MEDINA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442563332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307233256 | ||||||||
| FaxNumber: | 3307226731 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 04/05/2010 | ||||||||
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| AuthorizedOfficialLastName: | KASE | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 3307233256 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OH | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | CG5910 | 01 | OH | RAILROAD MEDICARE | OTHER | 100462 | 01 | OH | KAISER | OTHER | 2192961 | 05 | OH | MEDICAID |