MEDICARE: DR. JESSICA TOOREDMAN CASEY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	125054160	IL
2	2088P0231X	Pediatric Urology Physician	01074156A	IN
3	208800000X	Urology Physician	01074156A	IN
4	2088P0231X	Pediatric Urology Physician	16320	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	V113933	OTHER	NV	MEDICARE PTAN

General Provider Information

NPI Number	:	1396901765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA TOOREDMAN CASEY MD

Provider Business Mailing Address
First Line	:	717 PINNACLE HEIGHTS LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-0911
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6670 S TENAYA WAY
Second Line	:	SUITE 180
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-1966
Country	:	US
Telephone Number	:	702-369-4999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2008
Last Update Date	:	08/11/2016

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