Basic Information
| Provider Information | |||||||||
| NPI: | 1043273329 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASEY | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4750 HEMPSTEAD STATION DR | ||||||||
| Address2: | |||||||||
| City: | KETTERING | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454295164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008750136 | ||||||||
| FaxNumber: | 9376194231 | ||||||||
| Practice Location | |||||||||
| Address1: | 2213 CHERRY ST | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436082603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192513232 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2006 | ||||||||
| LastUpdateDate: | 05/29/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 34007421 | OH | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2316970 | 05 | OH | MEDICAID | 114871864 | 05 | MI | MEDICAID | P00212617 | 01 | OH | RAILROAD MEDICARE # | OTHER | 000000360662 | 01 | OH | BC/BS INDIVIDUAL # | OTHER | 114769163 | 05 | OH | MEDICAID | 114734060 | 05 | MI | MEDICAID | 727151 | 01 | OH | BUCKEY COMMUNITY # | OTHER | 000000377186 | 01 | OH | BC/BS ST. CHARLESNONPAR | OTHER | P00318337 | 01 | OH | MEDICARE RAIL ROAD | OTHER |