Healthcare Provider Details

I. General information

NPI: 1649534157
Provider Name (Legal Business Name): CASEY LEE LITCHKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2012
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7435 W TALCOTT AVE RESURRECTION EM RESIDENCY
CHICAGO IL
60631-3707
US

IV. Provider business mailing address

ESSENTIA HEALTH DULUTH CLINIC - MCL2CRED 400 EAST THIRD STREET
DULUTH MN
55805-1951
US

V. Phone/Fax

Practice location:
  • Phone: 773-792-7921
  • Fax:
Mailing address:
  • Phone: 218-786-8319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number65948
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number125-061009
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: