Provider Demographics
NPI:1215992516
Name:CASANOVA, PEDRO FERNANDO (MD)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:FERNANDO
Last Name:CASANOVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2013 S MCCALL RD
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223-4501
Mailing Address - Country:US
Mailing Address - Phone:941-474-4499
Mailing Address - Fax:941-474-0447
Practice Address - Street 1:2013 S MCCALL RD
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-4501
Practice Address - Country:US
Practice Address - Phone:941-474-0625
Practice Address - Fax:941-474-0447
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67308207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5165660OtherAETNA
FL26632OtherBCBS
FLK4178OtherPTAN
FLK4178OtherPTAN
FL26632XMedicare ID - Type Unspecified
FLK4178OtherPTAN