Provider Demographics
NPI:1376544296
Name:CASAD, CONNIE (MD)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:
Last Name:CASAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12200 PARK CENTRAL DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-2100
Mailing Address - Country:US
Mailing Address - Phone:972-566-7744
Mailing Address - Fax:972-566-8461
Practice Address - Street 1:12200 PARK CENTRAL DR
Practice Address - Street 2:SUITE 200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-2100
Practice Address - Country:US
Practice Address - Phone:972-566-7744
Practice Address - Fax:972-566-8461
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3219207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC14262Medicare UPIN
TX610394Medicare ID - Type Unspecified