Healthcare Provider Details

I. General information

NPI: 1801825542
Provider Name (Legal Business Name): JOHN WALTON MCCASKILL PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 W 13 MILE RD FSC
ROYAL OAK MI
48073-6712
US

IV. Provider business mailing address

3601 W 13 MILE RD FSC
ROYAL OAK MI
48073-6712
US

V. Phone/Fax

Practice location:
  • Phone: 248-423-2454
  • Fax: 248-423-2576
Mailing address:
  • Phone: 248-423-2454
  • Fax: 248-423-2576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301012562
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: