Provider Demographics
NPI:1386728103
Name:PEDRO F CASANOVA MD PA
Entity type:Organization
Organization Name:PEDRO F CASANOVA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:FERNANDO
Authorized Official - Last Name:CASANOVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-474-4499
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67308207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110228472OtherRAILROAD MEDICARE
FL5165660OtherAETNA
FL266253035OtherTRICARE
FL26632OtherBLUECROSS BLUESHIELD
FL6210832OtherCIGNA
FL5165660OtherAETNA
FL377217900Medicaid
FL110228472OtherRAILROAD MEDICARE