Provider Demographics
NPI:1871616995
Name:CASEY, KENNETH LYMAN (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:LYMAN
Last Name:CASEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2775 HEATHER WAY
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-2852
Mailing Address - Country:US
Mailing Address - Phone:734-971-4207
Mailing Address - Fax:734-971-7915
Practice Address - Street 1:2775 HEATHER WAY
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2852
Practice Address - Country:US
Practice Address - Phone:734-971-4207
Practice Address - Fax:734-971-7915
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010297472084N0400X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine