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General NPI Number Information
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NPI Number | 1265492748
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Entity Type | Individual
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Provider Name | ROBERTO A PENNE-CASANOVA MD
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Gender | Male
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Dates
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Enumeration Date | 03/27/2006
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Last Update Date | 07/01/2010
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Provider Practice Location Address
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Address Line | 3991 DUTCHMANS LN MEDICAL PLAZA II STE G03
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City | LOUISVILLE
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State | KY
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Zip | 40207-4700
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Country | US
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Telephone | 502-899-6100
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Fax | 502-899-6108
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Provider Business Mailing Address
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Address Line | PO BOX 847
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City | PROSPECT
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State | KY
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Zip | 40059
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Country | US
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Telephone | 502-386-9415
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Fax | 502-899-6108
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | 37074
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License Number State | KY
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