Healthcare Provider Details

I. General information

NPI: 1053150557
Provider Name (Legal Business Name): ABIGAIL ELIZABETH CASMERE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2024
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 E 86TH ST STE 104
INDIANAPOLIS IN
46240-1852
US

IV. Provider business mailing address

6619 WALNUT GROVE CT
DOWNERS GROVE IL
60516-3035
US

V. Phone/Fax

Practice location:
  • Phone: 317-257-1484
  • Fax: 317-257-1488
Mailing address:
  • Phone: 630-796-1483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10005170A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: