Healthcare Provider Details

I. General information

NPI: 1811384134
Provider Name (Legal Business Name): CARLOS ALBERTO MILLAN CORTES M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2015
Last Update Date: 04/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 WAYNE AVE APT 13R
BRONX NY
10467-2510
US

IV. Provider business mailing address

3450 WAYNE AVE APT 13R
BRONX NY
10467-2510
US

V. Phone/Fax

Practice location:
  • Phone: 718-644-4101
  • Fax:
Mailing address:
  • Phone: 718-644-4101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License NumberP87702
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: