Provider Demographics
NPI:1609859149
Name:CASEMORE, GAIL MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:MARIE
Last Name:CASEMORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4520 CENTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:VADNAIS HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55127-3602
Mailing Address - Country:US
Mailing Address - Phone:651-426-1141
Mailing Address - Fax:651-426-1705
Practice Address - Street 1:4520 CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:VADNAIS HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55127-3602
Practice Address - Country:US
Practice Address - Phone:651-426-1141
Practice Address - Fax:651-426-1705
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-29
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN26545208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNG50749Medicare UPIN