Provider Demographics
NPI:1003815671
Name:CASAVANT, MATTHEW STEPHAN (DO)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:STEPHAN
Last Name:CASAVANT
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1900 DON WICKHAM DRIVE
Mailing Address - Street 2:STE 120
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-1947
Mailing Address - Country:US
Mailing Address - Phone:352-241-7050
Mailing Address - Fax:352-241-7035
Practice Address - Street 1:1900 DON WICKHAM DRIVE
Practice Address - Street 2:STE 120
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1947
Practice Address - Country:US
Practice Address - Phone:352-241-7050
Practice Address - Fax:352-241-7035
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2023-04-26
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Provider Licenses
StateLicense IDTaxonomies
FLOS8678207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264093700Medicaid
FLH54064Medicare UPIN
FL264093700Medicaid