Provider Demographics
NPI:1538121082
Name:BISOGNO, CHARLES D (DO)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:D
Last Name:BISOGNO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:201 HILDA ST
Mailing Address - Street 2:SUITE 14
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-2320
Mailing Address - Country:US
Mailing Address - Phone:407-846-8288
Mailing Address - Fax:407-846-3162
Practice Address - Street 1:201 HILDA ST
Practice Address - Street 2:SUITE 14
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-2320
Practice Address - Country:US
Practice Address - Phone:407-846-8288
Practice Address - Fax:407-846-3162
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS4508207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL82546OtherBLUECROSS BLUESHIELD
FLD27372Medicare UPIN
FL82546OtherBLUECROSS BLUESHIELD