Healthcare Provider Details

I. General information

NPI: 1285626184
Provider Name (Legal Business Name): TIMOTHY M CASEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 CHICAGO AVE CHILDRENS HOSPITALS AND CLINICS-PATHOLOGY-MPLS
MINNEAPOLIS MN
55404-4518
US

IV. Provider business mailing address

2910 CENTRE POINTE DR 35-121A, CHILDRENS HEALTH CARE
ROSEVILLE MN
55113-1182
US

V. Phone/Fax

Practice location:
  • Phone: 612-813-6280
  • Fax: 612-813-6951
Mailing address:
  • Phone: 651-855-2109
  • Fax: 651-855-2310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0213X
TaxonomyPediatric Pathology Physician
License Number34179
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: