MEDICARE: PEDRO LUCIO CARRILLO JR. M.D.

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	207R00000X	Internal Medicine Physician	52900	FL

General Provider Information

NPI Number	:	1396731303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEDRO LUCIO CARRILLO JR. M.D.

Provider Business Mailing Address
First Line	:	100 NW 27TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-5114
Country	:	US
Telephone Number	:	305-541-1606
Fax Number	:	305-649-1129

Provider Business Practice Location Address
First Line	:	100 NW 27TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-5114
Country	:	US
Telephone Number	:	305-541-1606
Fax Number	:	305-649-1129

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	07/08/2007

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