Provider Demographics
NPI:1427007699
Name:RASULO, PHILIP SALVATORE (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:SALVATORE
Last Name:RASULO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 39TH ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-2454
Mailing Address - Country:US
Mailing Address - Phone:941-746-0120
Mailing Address - Fax:941-746-8753
Practice Address - Street 1:724 39TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-2454
Practice Address - Country:US
Practice Address - Phone:941-746-0120
Practice Address - Fax:941-746-8753
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2014-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME37155207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL79615ZMedicare PIN
FLD58861Medicare UPIN