Healthcare Provider Details

I. General information

NPI: 1811936016
Provider Name (Legal Business Name): MICHAEL CASEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 02/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 AVENUE B
ELLISVILLE MS
39437-2080
US

IV. Provider business mailing address

PO BOX 247
LAUREL MS
39441-0247
US

V. Phone/Fax

Practice location:
  • Phone: 601-477-8553
  • Fax: 601-477-9158
Mailing address:
  • Phone: 601-399-6167
  • Fax: 601-399-6281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number06168
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: