Provider Demographics
NPI:1134151483
Name:CASUSO, ENRIQUE G (MD)
Entity type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:G
Last Name:CASUSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3271 NW 7TH ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-4141
Mailing Address - Country:US
Mailing Address - Phone:305-642-3396
Mailing Address - Fax:305-642-6622
Practice Address - Street 1:3271 NW 7TH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-4141
Practice Address - Country:US
Practice Address - Phone:305-642-3396
Practice Address - Fax:305-642-6622
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 403042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001697100Medicaid
FL96638VMedicare PIN
FLD63926Medicare UPIN