Provider Demographics
NPI:1447449426
Name:ENRIQUE G. CASUSO,M.D., P.A
Entity type:Organization
Organization Name:ENRIQUE G. CASUSO,M.D., P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ANABEL OR MABEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LA O OR PENATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-642-3396
Mailing Address - Street 1:3271 NW 7TH ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-4141
Mailing Address - Country:US
Mailing Address - Phone:305-642-3396
Mailing Address - Fax:305-642-6622
Practice Address - Street 1:3271 NW 7TH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-4141
Practice Address - Country:US
Practice Address - Phone:305-642-3396
Practice Address - Fax:305-642-6622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME403042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD63926Medicare UPIN
FL72448Medicare PIN