Healthcare Provider Details

I. General information

NPI: 1376554576
Provider Name (Legal Business Name): JULIO C CASAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 HERITAGE BLVD
IMMOKALEE FL
34142-2260
US

IV. Provider business mailing address

1454 MADISON AVE W
IMMOKALEE FL
34142-2200
US

V. Phone/Fax

Practice location:
  • Phone: 239-658-3000
  • Fax:
Mailing address:
  • Phone: 786-797-7223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberME42902
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME42902
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: