Provider Demographics
NPI:1063497857
Name:POLITANO, VICTOR ANTHONY JR (DO)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:ANTHONY
Last Name:POLITANO
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1400 W OAK ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4000
Mailing Address - Country:US
Mailing Address - Phone:407-846-9299
Mailing Address - Fax:407-846-8930
Practice Address - Street 1:1400 W OAK ST
Practice Address - Street 2:SUITE D
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4000
Practice Address - Country:US
Practice Address - Phone:407-846-9299
Practice Address - Fax:407-846-8930
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2009-08-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS0005193207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4307838OtherAETNA PROVIDER NUMBER
FL82904OtherBCBS PROVIDER NUMBER
FL401926OtherCIGNA PROVIDER NUMBER
FL062882400Medicaid
FL401926OtherCIGNA PROVIDER NUMBER
FL700029019Medicare PIN
FL82904Medicare PIN