Healthcare Provider Details

I. General information

NPI: 1972568467
Provider Name (Legal Business Name): KIRK C CASEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 INDEPENDENCE CIR
CHICO CA
95973-0258
US

IV. Provider business mailing address

100 INDEPENDENCE CIR
CHICO CA
95973-0258
US

V. Phone/Fax

Practice location:
  • Phone: 530-899-0134
  • Fax: 530-899-0142
Mailing address:
  • Phone: 530-899-0134
  • Fax: 530-899-0142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License NumberG61633
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: