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General NPI Number Information
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NPI Number | 1649534157
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Entity Type | Individual
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Provider Name | CASEY LEE LITCHKE MD
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Gender | Male
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Dates
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Enumeration Date | 06/28/2012
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Last Update Date | 09/08/2016
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Provider Practice Location Address
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Address Line | 7435 W TALCOTT AVE RESURRECTION EM RESIDENCY
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City | CHICAGO
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State | IL
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Zip | 60631-3707
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Country | US
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Telephone | 773-792-7921
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Fax |
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Provider Business Mailing Address
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Address Line | ESSENTIA HEALTH DULUTH CLINIC - MCL2CRED 400 EAST THIRD STREET
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City | DULUTH
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State | MN
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Zip | 55805-1951
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Country | US
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Telephone | 218-786-8319
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 65948
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License Number State | WI
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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 | 125-061009
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License Number State | IL
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