Provider Demographics
NPI:1780607044
Name:CASAMENTO, JEFFREY BERNARD (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:BERNARD
Last Name:CASAMENTO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:245 CHERRY ST SE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4607
Mailing Address - Country:US
Mailing Address - Phone:616-459-3551
Mailing Address - Fax:616-459-1060
Practice Address - Street 1:245 CHERRY ST SE
Practice Address - Street 2:SUITE 202
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4607
Practice Address - Country:US
Practice Address - Phone:616-459-3551
Practice Address - Fax:616-459-1060
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2022-03-21
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Provider Licenses
StateLicense IDTaxonomies
MIJC063636208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3046021Medicaid
MIF78547Medicare UPIN
MI3046021Medicaid