Provider Demographics
NPI:1851501258
Name:SABAL, ANTONIO CASINO SR (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:CASINO
Last Name:SABAL
Suffix:SR
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 1:403 W CROFTON ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-7140
Mailing Address - Country:US
Mailing Address - Phone:480-892-9686
Mailing Address - Fax:480-892-9686
Practice Address - Street 1:18325 N ALLIED WAY STE 105
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85054-3106
Practice Address - Country:US
Practice Address - Phone:480-991-3399
Practice Address - Fax:480-719-3993
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10597207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ117689OtherMEDICARE PTAN