Provider Demographics
NPI:1518197946
Name:CASIANO, EMMANUAL DEJESUS (MD)
Entity Type:Individual
Prefix:DR
First Name:EMMANUAL
Middle Name:DEJESUS
Last Name:CASIANO
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 1:2072 OLDE TOWNE AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32550-4524
Mailing Address - Country:US
Mailing Address - Phone:850-622-1035
Mailing Address - Fax:850-622-1045
Practice Address - Street 1:2072 OLDE TOWNE AVE
Practice Address - Street 2:
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-4524
Practice Address - Country:US
Practice Address - Phone:850-622-1035
Practice Address - Fax:850-622-1045
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.026308207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery