Provider Demographics
NPI:1255039202
Name:CASEY, CHAZ KRISTOPHER (PA)
Entity type:Individual
Prefix:
First Name:CHAZ
Middle Name:KRISTOPHER
Last Name:CASEY
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:2975 N ADAMS RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-3786
Mailing Address - Country:US
Mailing Address - Phone:248-201-3976
Mailing Address - Fax:248-433-1415
Practice Address - Street 1:2975 N ADAMS RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-3786
Practice Address - Country:US
Practice Address - Phone:586-201-3976
Practice Address - Fax:248-433-1415
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2024-07-23
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Provider Licenses
StateLicense IDTaxonomies
MI5601011588363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant