=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942587761
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANGEL R CASADEMONT M D P A
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2011
-----------------------------------------------------
Last Update Date | 11/08/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6175 NW 153RD ST SUITE 320
-----------------------------------------------------
City | MIAMI LAKES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33014-2435
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-364-0220
-----------------------------------------------------
Fax | 305-364-1224
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6175 NW 153RD ST SUITE 320
-----------------------------------------------------
City | MIAMI LAKES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33014-2435
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-364-0220
-----------------------------------------------------
Fax | 305-364-1224
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ANGEL R CASADEMONT
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 305-364-0220
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | ME66714
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------