Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 33954 | TN |
NPI | 1134109804 |
---|---|
Provider Name | Dr. Michael T Casey JR. |
First Address | Knoxville, TN 37930-2569 |
Second Address | Knoxville, TN 37916-2435 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2006 |
Last Update Date | 06/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3851927 | (05) | TN |
H14067 | (02) |