Provider Demographics
NPI:1881631596
Name:CAZZANIGA, STEFANO (MD)
Entity Type:Individual
Prefix:
First Name:STEFANO
Middle Name:
Last Name:CAZZANIGA
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 1:902 W RANDOL MILL RD STE 150
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-2581
Mailing Address - Country:US
Mailing Address - Phone:817-417-9334
Mailing Address - Fax:817-417-9339
Practice Address - Street 1:902 W RANDOL MILL RD STE 150
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2581
Practice Address - Country:US
Practice Address - Phone:817-417-9334
Practice Address - Fax:817-417-9339
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD08649207R00000X
TXQ5363207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI110098873OtherRAILROAD MEDICARE
RI9002862Medicaid
TX436814YKPWMedicare PIN
RI9002862Medicaid