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General NPI Number Information
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NPI Number | 1639389992
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Entity Type | Individual
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Provider Name | PAUL CASEY MD
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Gender | Male
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 06/03/2010
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Provider Practice Location Address
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Address Line | 1653 W CONGRESS PKWY SUITE 177
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City | CHICAGO
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State | IL
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Zip | 60612-3833
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Country | US
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Telephone | 312-942-4978
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Fax | 312-942-4021
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Provider Business Mailing Address
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Address Line | 500 S CLINTON ST UNIT 620
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City | CHICAGO
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State | IL
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Zip | 60607-4319
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Country | US
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Telephone | 708-218-1094
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 125-050046
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 036119212
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License Number State | IL
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