Provider Demographics
NPI:1750368817
Name:CASEY, TYLER L (MD)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:L
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 1:6000 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8203
Mailing Address - Country:US
Mailing Address - Phone:515-241-2400
Mailing Address - Fax:515-241-2401
Practice Address - Street 1:6000 UNIVERSITY AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8203
Practice Address - Country:US
Practice Address - Phone:515-241-2400
Practice Address - Fax:515-241-2401
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA35930207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP00250716OtherRR MEDCARE
IA0467290Medicaid
IA1467290Medicaid
IA1750368817Medicaid
IAI15564Medicare ID - Type Unspecified
IA1750368817Medicaid