Basic Information
| Provider Information | |||||||||
| NPI: | 1942275979 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASSANEGO | ||||||||
| FirstName: | ANTONIO | ||||||||
| MiddleName: | SERGIO | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5849 OKEECHOBEE BLVD | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334174352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616834008 | ||||||||
| FaxNumber: | 5616830532 | ||||||||
| Practice Location | |||||||||
| Address1: | 5849 OKEECHOBEE BLVD | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334174352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616834008 | ||||||||
| FaxNumber: | 5616830532 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2006 | ||||||||
| LastUpdateDate: | 12/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 9700890 | NC | N | Other Service Providers | Specialist | 207R00000X | 9700890 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00403690 | 01 | RAILROAD MEDICARE INDIVID | OTHER | 1126M | 01 | NC | BCBS NC | OTHER | 891126M | 05 | NC | MEDICAID |