Provider Demographics
NPI:1619219995
Name:MCCLUSKEY, CASEY KATHLEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:KATHLEEN
Last Name:MCCLUSKEY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:705 RILEY HOSPITAL DR RM 5867
Mailing Address - Street 2:PEDIATRIC RESIDENCY PROGRAM INDIANA UNIVERSITY SOM
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5109
Mailing Address - Country:US
Mailing Address - Phone:317-944-4034
Mailing Address - Fax:317-944-1476
Practice Address - Street 1:705 RILEY HOSPITAL DR RM 5867
Practice Address - Street 2:PEDIATRIC RESIDENCY PROGRAM INDIANA UNIVERSITY SOM
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5109
Practice Address - Country:US
Practice Address - Phone:317-944-4034
Practice Address - Fax:317-944-1476
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-25
Last Update Date:2022-04-13
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Provider Licenses
StateLicense IDTaxonomies
OH1290152080P0203X
390200000X
WV290252080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program