Provider Demographics
NPI:1033164884
Name:ROBERT P CASOLA DO PA
Entity Type:Organization
Organization Name:ROBERT P CASOLA DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:CASOLA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:239-561-3090
Mailing Address - Street 1:PO BOX 61344
Mailing Address - Street 2:
Mailing Address - City:FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33906-1344
Mailing Address - Country:US
Mailing Address - Phone:239-274-5004
Mailing Address - Fax:239-274-5007
Practice Address - Street 1:13710 METROPOLIS AVE
Practice Address - Street 2:#104
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-7144
Practice Address - Country:US
Practice Address - Phone:239-561-3090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL80017Medicare ID - Type Unspecified