MEDICARE: CARLOS TELLECHEA MD

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	208000000X	Pediatrics Physician	ME35652	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	:	1578551131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS TELLECHEA MD

Provider Business Mailing Address
First Line	:	900 S PINE ISLAND RD
Second Line	:	SUITE 800
City	:	PLANTATION
State	:	FL
Zip	:	33324-3920
Country	:	US
Telephone Number	:	305-821-8611
Fax Number	:	305-827-1753

Provider Business Practice Location Address
First Line	:	15507-15 NW 67TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33014-2174
Country	:	US
Telephone Number	:	305-821-8611
Fax Number	:	305-827-1753

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

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	10/09/2013

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