Provider Demographics
NPI:1386757953
Name:MULCIHY, CASEY (MD)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:MULCIHY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4007 JAMES CASEY ST
Mailing Address - Street 2:SUITE D200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-3355
Mailing Address - Country:US
Mailing Address - Phone:512-447-5588
Mailing Address - Fax:512-447-6990
Practice Address - Street 1:5625 EIGER RD STE 225
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-8983
Practice Address - Country:US
Practice Address - Phone:512-447-5588
Practice Address - Fax:512-447-6990
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG5413208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130738104Medicaid
TX130738104Medicaid
TX00JQ41Medicare PIN