Provider Demographics
NPI:1689646440
Name:CASANOVA, RENE (MD)
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:
Last Name:CASANOVA
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 1:750 S FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-5767
Mailing Address - Country:US
Mailing Address - Phone:954-421-8181
Mailing Address - Fax:954-426-2967
Practice Address - Street 1:750 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-5767
Practice Address - Country:US
Practice Address - Phone:954-421-8181
Practice Address - Fax:954-426-2967
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78770208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264910101Medicaid
FLF70640Medicare UPIN
FL264910101Medicaid