Provider Demographics
NPI:1730207317
Name:NGUYEN CASADO, KATHY N (MD)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:N
Last Name:NGUYEN CASADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:N
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3175 CITRUS TOWER BLVD
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6885
Mailing Address - Country:US
Mailing Address - Phone:352-243-0206
Mailing Address - Fax:352-243-1822
Practice Address - Street 1:3175 CITRUS TOWER BLVD STE B
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6885
Practice Address - Country:US
Practice Address - Phone:352-243-0206
Practice Address - Fax:352-243-1822
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108362207Q00000X, 207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036116083Medicaid
FL003128900Medicaid
ILCA4079OtherRR GROUP
FL003128900Medicaid
FL003128900Medicaid
ILP00414350OtherRR INDIVIDUAL