Provider Demographics
NPI:1184698722
Name:CASEY, MICHAEL P (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
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 1:368 THORNBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEMONT
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1660
Mailing Address - Country:US
Mailing Address - Phone:610-527-4123
Mailing Address - Fax:
Practice Address - Street 1:700 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-4022
Practice Address - Country:US
Practice Address - Phone:215-829-5027
Practice Address - Fax:215-829-6391
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD016266E207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00597795Medicaid
025095Medicare ID - Type Unspecified
PA00597795Medicaid