MEDICARE: THOMAS CARRASQUILLO, M.D., P.A.

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	208600000X	Surgery Physician	ME36576	FL

General Provider Information

NPI Number	:	1285717983
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS CARRASQUILLO, M.D., P.A.

Provider Business Mailing Address
First Line	:	1435 SE 8TH TER
Second Line	:	SUITE B
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-3289
Country	:	US
Telephone Number	:	239-458-8222
Fax Number	:	239-458-8220

Provider Business Practice Location Address
First Line	:	1435 SE 8TH TER
Second Line	:	SUITE B
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-3289
Country	:	US
Telephone Number	:	239-458-8222
Fax Number	:	239-458-8220

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. THOMAS CARRASQUILLO
Credential	:	M.D.
Telephone Number	:	239-458-8222

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	08/22/2020

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