Provider Demographics
NPI:1588665053
Name:CASEBIER, MARTY D (MD)
Entity Type:Individual
Prefix:MR
First Name:MARTY
Middle Name:D
Last Name:CASEBIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1010 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:POWDERLY
Mailing Address - State:KY
Mailing Address - Zip Code:42367-5463
Mailing Address - Country:US
Mailing Address - Phone:270-377-1604
Mailing Address - Fax:270-377-1684
Practice Address - Street 1:1010 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:POWDERLY
Practice Address - State:KY
Practice Address - Zip Code:42367-5463
Practice Address - Country:US
Practice Address - Phone:270-377-1604
Practice Address - Fax:270-377-1684
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY37380207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64068091Medicaid
H81660Medicare UPIN
KY0652415Medicare PIN