Healthcare Provider Details

I. General information

NPI: 1831308162
Provider Name (Legal Business Name): MARCO AURELIO LADINO AVELLANEDA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 03/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NW 12TH AVE
MIAMI FL
33136-1003
US

IV. Provider business mailing address

1400 NW 12TH AVE
MIAMI FL
33136-1003
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-6251
  • Fax: 305-243-3506
Mailing address:
  • Phone: 305-243-6251
  • Fax: 305-243-3506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME102976
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: