Healthcare Provider Details

I. General information

NPI: 1215909791
Provider Name (Legal Business Name): LISA M. CASEY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 W VILLARD AVE
GLENDALE WI
53209-4901
US

IV. Provider business mailing address

2400 W VILLARD AVE
GLENDALE WI
53209-4901
US

V. Phone/Fax

Practice location:
  • Phone: 414-527-8181
  • Fax:
Mailing address:
  • Phone: 414-527-8181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34.007011
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number81494-21
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number72480
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS014887
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: