Provider Demographics
NPI:1396723706
Name:PROUGH, CASEY S (MD)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:S
Last Name:PROUGH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4045 NE LAKEWOOD WAY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-1799
Mailing Address - Country:US
Mailing Address - Phone:816-886-2184
Mailing Address - Fax:816-886-2397
Practice Address - Street 1:4045 NE LAKEWOOD WAY
Practice Address - Street 2:SUITE 130
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-1799
Practice Address - Country:US
Practice Address - Phone:816-886-2184
Practice Address - Fax:816-886-2397
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2014-09-29
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Provider Licenses
StateLicense IDTaxonomies
MO20050162142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1396723706Medicaid
LA76898Medicare UPIN
MO206245508Medicare PIN
MO1396723706Medicaid