MEDICARE: MARIO R VILLOCH MD GROUP LLC

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	173000000X	Legal Medicine	ME 59094	FL

General Provider Information

NPI Number	:	1437284916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIO R VILLOCH MD GROUP LLC

Provider Business Mailing Address
First Line	:	5005 ORDUNA DR
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33146-2036
Country	:	US
Telephone Number	:	305-662-2592
Fax Number	:

Provider Business Practice Location Address
First Line	:	2075 SW 27TH AVE FL 1
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33145-2540
Country	:	US
Telephone Number	:	305-856-6081
Fax Number	:	305-854-5968

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARIO R VILLOCH
Credential	:	M.D.,
Telephone Number	:	305-856-6081

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	08/22/2020

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