Provider Demographics
NPI:1972651164
Name:CARCASSONI, LUANA (MD)
Entity Type:Individual
Prefix:DR
First Name:LUANA
Middle Name:
Last Name:CARCASSONI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2899 COLLINS AVE
Mailing Address - Street 2:APT 1626
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33140-4422
Mailing Address - Country:US
Mailing Address - Phone:305-538-5239
Mailing Address - Fax:
Practice Address - Street 1:4578 W 12TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3325
Practice Address - Country:US
Practice Address - Phone:305-538-5239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL47161207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL042910400Medicaid
FLE22228Medicare UPIN
FL969094Medicare ID - Type Unspecified