MEDICARE: PEDRO A SEVILLA, MD, PA

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	174400000X	Specialist	ME107719	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ME107719	OTHER	FL	MEDICAL LICENSE

General Provider Information

NPI Number	:	1801177373
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDRO A SEVILLA, MD, PA

Provider Business Mailing Address
First Line	:	9066 SW 73RD CT
Second Line	:	SUITE 2009
City	:	MIAMI
State	:	FL
Zip	:	33156-2964
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9066 SW 73RD CT
Second Line	:	SUITE 2009
City	:	MIAMI
State	:	FL
Zip	:	33156-2964
Country	:	US
Telephone Number	:	305-458-9555
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PEDRO A SEVILLA SAEZ-BENITO
Credential	:	M.D.
Telephone Number	:	305-458-9555

Provider Enumeration Date	:	08/29/2011
Last Update Date	:	08/29/2011

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