Healthcare Provider Details

I. General information

NPI: 1750726287
Provider Name (Legal Business Name): MARC CILLO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2013
Last Update Date: 09/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 FANNIN ST SUITE 600
HOUSTON TX
77030-5389
US

IV. Provider business mailing address

6410 FANNIN ST SUITE 600
HOUSTON TX
77030-5389
US

V. Phone/Fax

Practice location:
  • Phone: 832-325-7161
  • Fax: 713-383-1467
Mailing address:
  • Phone: 832-325-7161
  • Fax: 713-383-1467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberR8170
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: