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NPI Code Detail

MEDICARE: DR. GAIL MARIE CASEMORE M.D.

MEDICARE: DR. GAIL MARIE CASEMORE 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
1208000000XPediatrics Physician26545MN

General Provider Information

NPI Number : 1609859149
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GAIL MARIE CASEMORE M.D.
Provider Business Mailing Address
First Line : 4520 CENTERVILLE RD
Second Line :
City : VADNAIS HEIGHTS
State : MN
Zip : 55127-3602
Country : US
Telephone Number : 651-426-1141
Fax Number : 651-426-1705
Provider Business Practice Location Address
First Line : 4520 CENTERVILLE RD
Second Line :
City : VADNAIS HEIGHTS
State : MN
Zip : 55127-3602
Country : US
Telephone Number : 651-426-1141
Fax Number : 651-426-1705
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2005
Last Update Date : 07/08/2007

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