MEDICARE: ANGEL L COLON-MOLERO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME168899	FL
2	207R00000X	Internal Medicine Physician	MD489579	PA
3	207R00000X	Internal Medicine Physician	10725	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DM 103093	OTHER	PR	STATE DRUG LIC.

General Provider Information

NPI Number	:	1063415727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGEL L COLON-MOLERO MD

Provider Business Mailing Address
First Line	:	11852 BATELLO LN
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32827-7100
Country	:	US
Telephone Number	:	305-968-0811
Fax Number	:

Provider Business Practice Location Address
First Line	:	5822 S SEMORAN BLVD BLDG A
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-4812
Country	:	US
Telephone Number	:	305-575-3419
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	04/21/2026

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