Provider Demographics
NPI:1184932964
Name:MICHAELS, CASEEM (CASEEM MICHAELS)
Entity type:Individual
Prefix:MR
First Name:CASEEM
Middle Name:
Last Name:MICHAELS
Suffix:
Gender:M
Credentials:CASEEM MICHAELS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2123 W DR MARTIN LUTHER KING DR BLVD
Mailing Address - Street 2:103
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607
Mailing Address - Country:US
Mailing Address - Phone:352-684-0820
Mailing Address - Fax:
Practice Address - Street 1:2123 W DR LUTHER KING DR BLVD
Practice Address - Street 2:#103
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607
Practice Address - Country:US
Practice Address - Phone:813-873-1361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1188JTC208100000X
FL225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1199JTCMedicare PIN