Healthcare Provider Details

I. General information

NPI: 1154416683
Provider Name (Legal Business Name): GABRIEL CILLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 NO DIXIE HWY 101
FT. LAUDERDALE FL
33334
US

IV. Provider business mailing address

5601 NO DIXIE HWY 101
FT. LAUDERDALE FL
33334
US

V. Phone/Fax

Practice location:
  • Phone: 954-491-1600
  • Fax: 954-928-0792
Mailing address:
  • Phone: 954-491-1600
  • Fax: 954-928-0792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME 50288
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: