Provider Demographics
NPI:1487844304
Name:CASEY, KEVIN M (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:M
Last Name:CASEY
Suffix:
Gender:M
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:PO BOX 1206
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93116-1206
Mailing Address - Country:US
Mailing Address - Phone:619-532-7580
Mailing Address - Fax:
Practice Address - Street 1:520 W JUNIPERO ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4212
Practice Address - Country:US
Practice Address - Phone:805-730-1470
Practice Address - Fax:805-730-1473
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2019-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1076082086S0129X
LA200459390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA107608OtherMEDICAL BOARD OF CA
LA1058157Medicaid