Provider Demographics
NPI:1932115052
Name:CASEY, NINA Z (MD)
Entity Type:Individual
Prefix:DR
First Name:NINA
Middle Name:Z
Last Name:CASEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROMEO
Mailing Address - State:MI
Mailing Address - Zip Code:48065-5130
Mailing Address - Country:US
Mailing Address - Phone:586-752-2861
Mailing Address - Fax:586-752-1867
Practice Address - Street 1:239 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ROMEO
Practice Address - State:MI
Practice Address - Zip Code:48065-5130
Practice Address - Country:US
Practice Address - Phone:586-752-2861
Practice Address - Fax:586-752-1867
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301072657207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH45815Medicare UPIN
MI0P20730Medicare ID - Type Unspecified