MEDICARE: EMILIO LUIS GONZALEZ 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	207Q00000X	Family Medicine Physician	ME 108178	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	:	1750690061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILIO LUIS GONZALEZ M.D.

Provider Business Mailing Address
First Line	:	8400 NW 33RD ST
Second Line	:	SUIT 201
City	:	DORAL
State	:	FL
Zip	:	33122-1937
Country	:	US
Telephone Number	:	786-408-8502
Fax Number	:	305-921-7355

Provider Business Practice Location Address
First Line	:	8400 NW 33RD ST
Second Line	:	SUIT 201
City	:	DORAL
State	:	FL
Zip	:	33122-1937
Country	:	US
Telephone Number	:	786-408-8502
Fax Number	:	305-921-7355

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

Provider Enumeration Date	:	10/04/2010
Last Update Date	:	04/11/2017

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