Provider Demographics
NPI:1841209806
Name:CASIS, FERDINAND C (MD,FACE)
Entity Type:Individual
Prefix:DR
First Name:FERDINAND
Middle Name:C
Last Name:CASIS
Suffix:
Gender:M
Credentials:MD,FACE
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 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7210
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:720 S VANBUREN ST
Practice Address - Street 2:SUITE 104
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3538
Practice Address - Country:US
Practice Address - Phone:920-433-6050
Practice Address - Fax:920-433-6049
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301102839207RE0101X
WI47960207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34635100Medicaid
WIH25469Medicare UPIN
WI071700065Medicare Oscar/Certification
MIOP383400041Medicare Oscar/Certification
WIK400120272Medicare Oscar/Certification
WI34635100Medicaid
WIK400175344Medicare Oscar/Certification
WI430800042Medicare Oscar/Certification
WI030280037Medicare Oscar/Certification
WI330350047Medicare Oscar/Certification
WI430600003Medicare Oscar/Certification