Healthcare Provider Details

I. General information

NPI: 1356801112
Provider Name (Legal Business Name): NICHOLAS ITALO PILLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 CAMPO SANO AVE
CORAL GABLES FL
33146-1174
US

IV. Provider business mailing address

1150 CAMPO SANO AVE
CORAL GABLES FL
33146-1174
US

V. Phone/Fax

Practice location:
  • Phone: 786-308-2152
  • Fax: 786-533-9829
Mailing address:
  • Phone: 786-308-2152
  • Fax: 786-533-9829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME168085
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberME168085
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: