MEDICARE: INDIRA MARMOLEJOS MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician	ME99093	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174829121
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDIRA MARMOLEJOS MD PA

Provider Business Mailing Address
First Line	:	6238 W ATLANTIC AVE
Second Line	:	SUITE 2
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-3501
Country	:	US
Telephone Number	:	561-404-9845
Fax Number	:	561-404-9849

Provider Business Practice Location Address
First Line	:	6238 W ATLANTIC AVE
Second Line	:	SUITE 2
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-3501
Country	:	US
Telephone Number	:	561-404-9845
Fax Number	:	561-404-9849

Authorized Official
Title or Position	:	PRESIDENT
Name	:	INDIRA MARIBEL MARMOLEJOS
Credential	:	M.D
Telephone Number	:	561-404-9845

Provider Enumeration Date	:	02/08/2011
Last Update Date	:	07/21/2016

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