Provider Demographics
NPI:1710088380
Name:MARTIN, CASEY S (MD)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:S
Last Name:MARTIN
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 1:580 RICE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55103-2148
Mailing Address - Country:US
Mailing Address - Phone:651-227-6551
Mailing Address - Fax:651-665-0684
Practice Address - Street 1:580 RICE ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55103-2148
Practice Address - Country:US
Practice Address - Phone:651-227-6551
Practice Address - Fax:651-665-0684
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN38855207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN112864OtherUCARE NUMBER
IA1536748Medicaid
MN01-03705OtherMEDICA CHOICE/DUAL/PTCH #
MN1016634OtherPREFERRED ONE NUMBER
WI34284200Medicaid
MN26G29MAOtherBCBS NUMBER
MN773469OtherAMERICA'S PPO NUMBER
MNHP26164OtherHEALTHPARTNERS NUMBER
MNG49571Medicare UPIN