MEDICARE: ANTHONY F BRILLANTE 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	ME22652	FL

General Provider Information

NPI Number	:	1750669651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY F BRILLANTE M.D.

Provider Business Mailing Address
First Line	:	1601 N,W 114TH AVE
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33026-2539
Country	:	US
Telephone Number	:	954-431-0921
Fax Number	:	954-966-3473

Provider Business Practice Location Address
First Line	:	1601 NW 114TH AVE
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33026-2539
Country	:	US
Telephone Number	:	954-431-0921
Fax Number	:

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

Provider Enumeration Date	:	07/26/2011
Last Update Date	:	07/26/2011

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