Provider Demographics
NPI:1548336266
Name:CASEY, AMBER RAYNEE (DO)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:RAYNEE
Last Name:CASEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:SUITE M020
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-341-8400
Mailing Address - Fax:269-341-8427
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:SUITE M020
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-341-8400
Practice Address - Fax:269-341-8427
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2014-11-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101013839207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1548336266Medicaid
MI1151300535OtherBLUE CROSS
MI1104840529OtherBCBSM - BRONSON
MI430660811Medicaid
MIM20520106 BRONSONMedicare PIN
MI1548336266Medicaid
H32960Medicare UPIN