Basic Information
| Provider Information | |||||||||
| NPI: | 1538154497 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CASANOVA & CASANOVA MD'S PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3508 TAMIAMI TRL | ||||||||
| Address2: | SUITE C | ||||||||
| City: | PORT CHARLOTTE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339528160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9418833313 | ||||||||
| FaxNumber: | 9418833320 | ||||||||
| Practice Location | |||||||||
| Address1: | 3508 TAMIAMI TRL | ||||||||
| Address2: | SUITE C | ||||||||
| City: | PORT CHARLOTTE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339528160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9418833313 | ||||||||
| FaxNumber: | 9418833320 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2005 | ||||||||
| LastUpdateDate: | 06/06/2011 | ||||||||
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| AuthorizedOfficialLastName: | CASANOVA | ||||||||
| AuthorizedOfficialFirstName: | LUIS | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9418833313 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 207RG0300X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 34749 | 01 | FL | BC/BS GROUP NUMBER | OTHER |