Provider Demographics
NPI:1184621823
Name:CASINO, W PHILIP R (MD)
Entity type:Individual
Prefix:DR
First Name:W PHILIP
Middle Name:R
Last Name:CASINO
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 1:901 SAINT MARYS DR STE 300
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-0521
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:901 SAINT MARYS DR
Practice Address - Street 2:SUITE 300
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0520
Practice Address - Country:US
Practice Address - Phone:812-473-2642
Practice Address - Fax:812-474-4458
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01047595A207RC0000X, 207RI0011X
KY33473207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY33473OtherKY LICENSE
IN01047595AOtherIN LICENSE
G61996Medicare UPIN
IN01047595AOtherIN LICENSE
INM400031566Medicare PIN
G61996Medicare UPIN
KYP00897774OtherRR MEDICARE