Individual
CASEY S PROUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4045 NE LAKEWOOD WAY, SUITE 130, LEES SUMMIT, MO 64064-1799
(816) 886-2184
(816) 886-2397
Mailing address
4045 NE LAKEWOOD WAY, SUITE 130, LEES SUMMIT, MO 64064-1799
(816) 886-2184
(816) 886-2397
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
2005016214
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1396723706
—
MO
Enumeration date
01/05/2006
Last updated
09/29/2014
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