Individual
DR. ROBERTO A PENNE-CASANOVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3991 DUTCHMANS LN, MEDICAL PLAZA II STE G03, LOUISVILLE, KY 40207-4700
(502) 899-6100
(502) 899-6108
Mailing address
PO BOX 847, PROSPECT, KY 40059
(502) 386-9415
(502) 899-6108
Taxonomy
Speciality
Code
Description
License number
State
2083X0100X
Occupational Medicine Physician
Primary
37074
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000235989
ANTHEM BLUE CROSS BLUE SHIELD
KY
01
—
1170390
PASSPORT HEALTH PLAN
KY
05
—
200386450A
—
IN
01
—
2440625000
PASSPORT ADVANTAGE
KY
05
—
64048564
—
KY
01
—
P00022895
RAILROAD MEDICARE
KY
Enumeration date
03/27/2006
Last updated
07/01/2010
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