Provider Demographics
NPI:1316946726
Name:CASOLO, BRADLEY J (MD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:J
Last Name:CASOLO
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 1:8932 SW 97TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1936
Mailing Address - Country:US
Mailing Address - Phone:305-243-5512
Mailing Address - Fax:
Practice Address - Street 1:8932 SW 97TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1936
Practice Address - Country:US
Practice Address - Phone:305-243-5512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1678282085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1679045-06Medicaid
TX167904501Medicaid
TX167904502Medicaid
TX8C1373Medicare ID - Type Unspecified'OTHER' COUNTIES
TX8C1371Medicare ID - Type UnspecifiedDALLAS COUNTY
TX1679045-06Medicaid
TXTXB120623Medicare PIN