MEDICARE: DR. EMMANUAL DEJESUS CASIANO 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
1	207X00000X	Orthopaedic Surgery Physician	35.026308	OH

General Provider Information

NPI Number	:	1518197946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMMANUAL DEJESUS CASIANO MD

Provider Business Mailing Address
First Line	:	2072 OLDE TOWNE AVE
Second Line	:
City	:	MIRAMAR BEACH
State	:	FL
Zip	:	32550-4524
Country	:	US
Telephone Number	:	850-622-1035
Fax Number	:	850-622-1045

Provider Business Practice Location Address
First Line	:	2072 OLDE TOWNE AVE
Second Line	:
City	:	MIRAMAR BEACH
State	:	FL
Zip	:	32550-4524
Country	:	US
Telephone Number	:	850-622-1035
Fax Number	:	850-622-1045

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2009
Last Update Date	:	07/20/2009

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