Provider Demographics
NPI:1538154497
Name:CASANOVA & CASANOVA MD'S PA
Entity type:Organization
Organization Name:CASANOVA & CASANOVA MD'S PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:CASANOVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-883-3313
Mailing Address - Street 1:3508 TAMIAMI TRL
Mailing Address - Street 2:SUITE C
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-8160
Mailing Address - Country:US
Mailing Address - Phone:941-883-3313
Mailing Address - Fax:941-883-3320
Practice Address - Street 1:3508 TAMIAMI TRL
Practice Address - Street 2:SUITE C
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8160
Practice Address - Country:US
Practice Address - Phone:941-883-3313
Practice Address - Fax:941-883-3320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34749OtherBC/BS GROUP NUMBER
FL34749Medicare ID - Type UnspecifiedGROUP NUMBER