Provider Demographics
NPI:1215135918
Name:CASPER, TRAVIS WADE (MD)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:WADE
Last Name:CASPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3245 HEALTH DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-3245
Mailing Address - Country:US
Mailing Address - Phone:574-647-1840
Mailing Address - Fax:
Practice Address - Street 1:2235 CLEVELAND RD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46628-3529
Practice Address - Country:US
Practice Address - Phone:574-647-4530
Practice Address - Fax:574-647-2285
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01068197A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200982160Medicaid
IN200982160Medicaid
IN000000722382OtherBCBS BMG E BLAIR WARNER
IN11013703AOtherMEDICAL RESIDENCY PERMIT
IN200982160Medicaid
INP00890338OtherRR MEDICARE
INM400052791Medicare PIN
IN200982160Medicaid