Provider Demographics
NPI:1811203805
Name:CASEY, GERALD MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:MICHAEL
Last Name:CASEY
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 1:16 W BAY RD
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1056
Mailing Address - Country:US
Mailing Address - Phone:708-361-2248
Mailing Address - Fax:
Practice Address - Street 1:16 W BAY RD
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1056
Practice Address - Country:US
Practice Address - Phone:708-361-2248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-54085207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine