Healthcare Provider Details

I. General information

NPI: 1992292031
Provider Name (Legal Business Name): CORINNE CASINO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2018
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 N LAKE SHORE DR
CHICAGO IL
60657-5640
US

IV. Provider business mailing address

4441 CHOUTEAU AVE APT 3205
SAINT LOUIS MO
63110-1692
US

V. Phone/Fax

Practice location:
  • Phone: 773-665-3000
  • Fax:
Mailing address:
  • Phone: 270-724-1214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA180830
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: