Provider Demographics
NPI:1447627492
Name:CASPER CARDIOLOGY
Entity type:Organization
Organization Name:CASPER CARDIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SKAF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-277-3867
Mailing Address - Street 1:428 S DURBIN ST STE 104
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2818
Mailing Address - Country:US
Mailing Address - Phone:307-337-4284
Mailing Address - Fax:
Practice Address - Street 1:428 S DURBIN ST STE 104
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2818
Practice Address - Country:US
Practice Address - Phone:307-337-4284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CEDARS HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY7159A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty