Healthcare Provider Details

I. General information

NPI: 1972879930
Provider Name (Legal Business Name): CASEY THOMAS PERKOWSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2012
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 E SHAFER AVE
DOVER OH
44622-2053
US

IV. Provider business mailing address

715 E SHAFER AVE
DOVER OH
44622-2053
US

V. Phone/Fax

Practice location:
  • Phone: 330-556-0440
  • Fax: 330-549-8089
Mailing address:
  • Phone: 330-556-0440
  • Fax: 330-549-8089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.125818
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: