MEDICARE: CASEY YANG M.D.

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	208600000X	Surgery Physician	4301503191	MI
2	208600000X	Surgery Physician	66582	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528455326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASEY YANG M.D.

Provider Business Mailing Address
First Line	:	303 E NICOLLET BLVD STE 300
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-4594
Country	:	US
Telephone Number	:	612-937-5762
Fax Number	:

Provider Business Practice Location Address
First Line	:	303 E NICOLLET BLVD STE 300
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-4594
Country	:	US
Telephone Number	:	612-937-5762
Fax Number	:

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

Provider Enumeration Date	:	04/20/2015
Last Update Date	:	11/17/2022

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