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General NPI Number Information
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NPI Number | 1457371213
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Entity Type | Organization
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Legal Business Name | MICHAEL L. CASELNOVA
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7209 GREEN SLOPE DR
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City | ZEPHYRHILLS
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State | FL
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Zip | 33541-1306
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Country | US
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Telephone | 813-782-2646
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Fax | 813-782-4988
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Provider Business Mailing Address
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Address Line | 7209 GREEN SLOPE DR
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City | ZEPHYRHILLS
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State | FL
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Zip | 33541-1306
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Country | US
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Telephone | 813-782-2646
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Fax | 813-782-4988
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. MICHAEL LEE CASELNOVA
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Credential | M.D.
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Telephone | 813-782-2646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME45762
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License Number State | FL
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