Healthcare Provider Details

I. General information

NPI: 1073731691
Provider Name (Legal Business Name): ROBERT T CASIMIR DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W GREENLAWN AVE
LANSING MI
48910-2819
US

IV. Provider business mailing address

1914 LOURDES CT
LANSING MI
48910-0617
US

V. Phone/Fax

Practice location:
  • Phone: 832-279-2369
  • Fax:
Mailing address:
  • Phone: 832-279-2369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberBI3539941D181
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: