Provider Demographics
NPI:1407833148
Name:CASANO, SALVATORE FRANK (MD)
Entity Type:Individual
Prefix:
First Name:SALVATORE
Middle Name:FRANK
Last Name:CASANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SAM
Other - Middle Name:FRANK
Other - Last Name:CASANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:333 E VIRGINIA AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1206
Mailing Address - Country:US
Mailing Address - Phone:602-253-7076
Mailing Address - Fax:602-253-7215
Practice Address - Street 1:333 E VIRGINIA AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1206
Practice Address - Country:US
Practice Address - Phone:602-253-7076
Practice Address - Fax:602-253-7215
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11370174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ227399Medicaid
AZD36649Medicare UPIN
AZD36649Medicare ID - Type Unspecified