Provider Demographics
NPI:1427040542
Name:CASEY, TIMOTHY J (DPM)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:J
Last Name:CASEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2020-04-10
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-04-10
Provider Licenses
StateLicense IDTaxonomies
IL016004717213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
04927009OtherBCBS OF ILLINOIS
U59199Medicare UPIN
04927009OtherBCBS OF ILLINOIS