Provider Demographics
NPI:1528047693
Name:CASAS, CHEYANNE M (MD)
Entity type:Individual
Prefix:
First Name:CHEYANNE
Middle Name:M
Last Name:CASAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 BLUE RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5409
Mailing Address - Country:US
Mailing Address - Phone:630-624-2030
Mailing Address - Fax:512-621-7973
Practice Address - Street 1:308 BLUE RIDGE TRL
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5409
Practice Address - Country:US
Practice Address - Phone:512-887-8418
Practice Address - Fax:512-621-7973
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36103609207Q00000X
TXP4636207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36103609Medicaid
IL36103609Medicaid
IL206016Medicare ID - Type Unspecified
279712YLDCMedicare PIN