=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386728103
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEDRO F CASANOVA MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2006
-----------------------------------------------------
Last Update Date | 10/30/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2013 S MCCALL RD
-----------------------------------------------------
City | ENGLEWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34223-4501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-474-0625
-----------------------------------------------------
Fax | 941-474-0447
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2013 S MCCALL RD
-----------------------------------------------------
City | ENGLEWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34223-4501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-474-4499
-----------------------------------------------------
Fax | 941-474-0447
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. PEDRO FERNANDO CASANOVA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 941-474-4499
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME67308
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------