Provider Demographics
NPI:1316053861
Name:MICHAEL G CASAGRANDE MD PA
Entity type:Organization
Organization Name:MICHAEL G CASAGRANDE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CASAGRANDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-357-1934
Mailing Address - Street 1:13628 MICHEL RD
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-6492
Mailing Address - Country:US
Mailing Address - Phone:281-357-1934
Mailing Address - Fax:281-803-5298
Practice Address - Street 1:13628 MICHEL RD
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-6492
Practice Address - Country:US
Practice Address - Phone:281-357-1934
Practice Address - Fax:281-803-5298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0435207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122057605Medicaid
TX0060PWOtherBCBS
TX0060PWOtherBCBS
TX=========OtherEIN
TX122057605Medicaid