Provider Demographics
NPI:1942035050
Name:STROTE, CASEY
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:STROTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5603 PRAIRIE ROSE LN
Mailing Address - Street 2:
Mailing Address - City:JOHNSBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60051-5234
Mailing Address - Country:US
Mailing Address - Phone:815-715-9993
Mailing Address - Fax:
Practice Address - Street 1:3711 W KANE AVE
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-5524
Practice Address - Country:US
Practice Address - Phone:779-244-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242007762390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program