MEDICARE: INDIRA M MARMOLEJOS 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	207RI0200X	Infectious Disease Physician	ME99093	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ME99093	OTHER	FL	LICENSURE

General Provider Information

NPI Number	:	1659535987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INDIRA M MARMOLEJOS M.D.

Provider Business Mailing Address
First Line	:	2605 W ATLANTIC AVE STE D101
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-4414
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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2008
Last Update Date	:	12/11/2024

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