Provider Demographics
NPI:1972879930
Name:PERKOWSKI, CASEY THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:THOMAS
Last Name:PERKOWSKI
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 1:659 BOULEVARD ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-2026
Mailing Address - Country:US
Mailing Address - Phone:330-602-0770
Mailing Address - Fax:
Practice Address - Street 1:205 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-2058
Practice Address - Country:US
Practice Address - Phone:330-343-7950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-23
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.125818207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine