Healthcare Provider Details

I. General information

NPI: 1164782454
Provider Name (Legal Business Name): MICHAEL ARTHUR CASEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2012
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 S MERIDIAN STE 101
PUYALLUP WA
98371-7590
US

IV. Provider business mailing address

1703 S MERIDIAN STE 101
PUYALLUP WA
98371-7590
US

V. Phone/Fax

Practice location:
  • Phone: 253-848-3000
  • Fax:
Mailing address:
  • Phone: 253-848-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberS-17-193
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number25MA10480400
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number61563
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number16-120
License Number StateNJ
# 5
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD61464042
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: