Basic Information
| Provider Information | |||||||||
| NPI: | 1376269985 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASWELL | ||||||||
| FirstName: | ALLISON | ||||||||
| MiddleName: | JANELLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 502 VANDENBURG HALL | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5176103753 | ||||||||
| FaxNumber: | 5176103753 | ||||||||
| Practice Location | |||||||||
| Address1: | 955 CAMPUS DR N | ||||||||
| Address2: | |||||||||
| City: | WATERFORD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483282754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2484756300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2022 | ||||||||
| LastUpdateDate: | 10/14/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | Y | 193400000X SINGLE SPECIALTY GROUP |
ID Information
| ID | Type | State | Issuer | Description | AJC2022 | 05 | MI | MEDICAID |