MEDICARE: DR. KASEY LAZ ABANONU JR. 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	207R00000X	Internal Medicine Physician	14139	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	V75834	OTHER	NV	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609109644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KASEY LAZ ABANONU JR. MD

Provider Business Mailing Address
First Line	:	4700 MILLENIA BLVD STE 650
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32839-6013
Country	:	US
Telephone Number	:	725-220-8706
Fax Number	:	833-749-0366

Provider Business Practice Location Address
First Line	:	4919 W CRAIG RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-2730
Country	:	US
Telephone Number	:	725-220-8706
Fax Number	:	833-749-0366

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

Provider Enumeration Date	:	09/09/2009
Last Update Date	:	12/02/2022

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