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General NPI Number Information
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NPI Number | 1841297942
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Entity Type | Individual
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Provider Name | LUIS A CASANOVA MD
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Gender | Male
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Dates
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Enumeration Date | 07/05/2005
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Last Update Date | 09/09/2020
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Provider Practice Location Address
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Address Line | 3508 TAMIAMI TRL SUITE C
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-8160
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Country | US
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Telephone | 941-883-3313
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Fax | 941-883-3320
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Provider Business Mailing Address
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Address Line | PO BOX 495790
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City | PORT CHARLOTTE
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State | FL
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Zip | 33949-5790
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Country | US
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Telephone | 941-883-3313
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Fax | 941-883-3320
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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 | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | ME0053174
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License Number State | FL
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