Provider Demographics
NPI:1366639130
Name:TIMOTHY CASEY DPM PC
Entity Type:Organization
Organization Name:TIMOTHY CASEY DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:847-360-1330
Mailing Address - Street 1:1790 NATIONS DR STE 106
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-9175
Mailing Address - Country:US
Mailing Address - Phone:847-360-1330
Mailing Address - Fax:847-360-9271
Practice Address - Street 1:1790 NATIONS DR STE 106
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-9175
Practice Address - Country:US
Practice Address - Phone:847-360-1330
Practice Address - Fax:847-360-9271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-004717332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
U59199Medicare UPIN
4192210001Medicare NSC