Provider Demographics
NPI:1407368749
Name:CASAS, EDWARD RAUL (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:RAUL
Last Name:CASAS
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 1:1603 ORRINGTON AVE STE 1600
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-5064
Mailing Address - Country:US
Mailing Address - Phone:847-583-1619
Mailing Address - Fax:847-583-1426
Practice Address - Street 1:1603 ORRINGTON AVE STE 1600
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-5064
Practice Address - Country:US
Practice Address - Phone:847-583-1619
Practice Address - Fax:847-583-1426
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036079635208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036079635OtherLICENSED PHYSICIAN AND SURGEON