Healthcare Provider Details

I. General information

NPI: 1245225622
Provider Name (Legal Business Name): ANTHONY J. CASALE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 04/04/2022
Certification Date: 04/04/2022
Deactivation Date: 03/23/2006
Reactivation Date: 04/04/2006

III. Provider practice location address

234 E GRAY ST SUITE 662
LOUISVILLE KY
40202-1900
US

IV. Provider business mailing address

PO BOX 950241
LOUISVILLE KY
40295-0241
US

V. Phone/Fax

Practice location:
  • Phone: 502-629-4220
  • Fax:
Mailing address:
  • Phone: 502-629-4220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number19584
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number19584
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: