Provider Demographics
NPI:1902857808
Name:CASEY, TERRENCE C (MD)
Entity Type:Individual
Prefix:
First Name:TERRENCE
Middle Name:C
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 1:505 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:EAST SAINT LOUIS
Mailing Address - State:IL
Mailing Address - Zip Code:62201-2919
Mailing Address - Country:US
Mailing Address - Phone:618-482-7330
Mailing Address - Fax:618-274-6437
Practice Address - Street 1:505 S 8TH ST
Practice Address - Street 2:
Practice Address - City:EAST SAINT LOUIS
Practice Address - State:IL
Practice Address - Zip Code:62201-2919
Practice Address - Country:US
Practice Address - Phone:618-482-7330
Practice Address - Fax:618-274-6437
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD395282084P0800X
IL0361230642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3332597Medicaid
I36134Medicare UPIN
TN3332616Medicare PIN