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NPI Code Detail

MEDICARE: EDWARD CASANOVA MD

MEDICARE: EDWARD CASANOVA MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry PhysicianN1576TX

General Provider Information

NPI Number : 1134311715
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDWARD CASANOVA MD
Provider Business Mailing Address
First Line : 4730 WOODSEND LN
Second Line :
City : KINGWOOD
State : TX
Zip : 77345-2559
Country : US
Telephone Number : 936-577-4324
Fax Number :
Provider Business Practice Location Address
First Line : 3737 DACOMA ST
Second Line :
City : HOUSTON
State : TX
Zip : 77092-8905
Country : US
Telephone Number : 713-970-8400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2007
Last Update Date : 09/16/2009

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