Provider Demographics
NPI:1982128062
Name:JAIME F CASELLAS MD CORP
Entity type:Organization
Organization Name:JAIME F CASELLAS MD CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:FELIPE
Authorized Official - Last Name:CASELLAS
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:813-389-2313
Mailing Address - Street 1:4600 N HABANA AVE STE 13
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-7123
Mailing Address - Country:US
Mailing Address - Phone:813-870-3278
Mailing Address - Fax:813-870-2294
Practice Address - Street 1:4600 N HABANA AVE SUIT #13
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614
Practice Address - Country:US
Practice Address - Phone:813-870-3278
Practice Address - Fax:813-870-2294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21457207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty