Provider Demographics
NPI:1063497857
Name:POLITANO, VICTOR ANTHONY JR (DO)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:ANTHONY
Last Name:POLITANO
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 NOLTE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34772-8762
Mailing Address - Country:US
Mailing Address - Phone:407-846-9247
Mailing Address - Fax:407-846-4430
Practice Address - Street 1:2155 NOLTE RD
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34772-8762
Practice Address - Country:US
Practice Address - Phone:407-846-9247
Practice Address - Fax:407-846-4430
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2024-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS0005193207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL062882400Medicaid
FL82904OtherBCBS PROVIDER NUMBER
FL401926OtherCIGNA PROVIDER NUMBER
FL4307838OtherAETNA PROVIDER NUMBER
FL401926OtherCIGNA PROVIDER NUMBER
FL700029019Medicare PIN
FL82904Medicare PIN