Provider Demographics
NPI:1659352656
Name:YOUNKIN, CASEY C (MD)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:C
Last Name:YOUNKIN
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 19640
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62794-9640
Mailing Address - Country:US
Mailing Address - Phone:217-545-5117
Mailing Address - Fax:217-545-4912
Practice Address - Street 1:415 N 9TH ST
Practice Address - Street 2:6TH FLOOR
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-5317
Practice Address - Country:US
Practice Address - Phone:217-545-5117
Practice Address - Fax:217-545-4912
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036077173207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036077173Medicaid
ILK00191Medicare PIN
IL256510Medicare PIN
C37330Medicare UPIN