MEDICARE: CASEY WOODS

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1871331892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASEY WOODS

Provider Business Mailing Address
First Line	:	2557 E BRUNSWICK RD
Second Line	:
City	:	BEECHER
State	:	IL
Zip	:	60401-3016
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2557 E BRUNSWICK RD
Second Line	:
City	:	BEECHER
State	:	IL
Zip	:	60401-3016
Country	:	US
Telephone Number	:	708-704-4246
Fax Number	:

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

Provider Enumeration Date	:	07/15/2024
Last Update Date	:	07/15/2024

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Directions to “ CASEY WOODS ” Practice Location

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