Provider Demographics
NPI:1386653699
Name:CASEY, COLLEEN LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:LOUISE
Last Name:CASEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2943 JONQUIL TRL N
Mailing Address - Street 2:
Mailing Address - City:LAKE ELMO
Mailing Address - State:MN
Mailing Address - Zip Code:55042-8478
Mailing Address - Country:US
Mailing Address - Phone:651-207-6003
Mailing Address - Fax:
Practice Address - Street 1:2828 CHICAGO AVE. SO.
Practice Address - Street 2:SUITE 400
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1320
Practice Address - Country:US
Practice Address - Phone:612-863-5390
Practice Address - Fax:612-863-2697
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN50783207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1011716Medicaid
VTCAVN3790Medicare ID - Type Unspecified
VT1011716Medicaid