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1821074683

NPI Code Detail

MEDICARE: DR. MARCO TULIO GONZALEZ MD

MEDICARE: DR. MARCO TULIO GONZALEZ 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	2080N0001X	Neonatal-Perinatal Medicine Physician	50288	AZ
2	2080N0001X	Neonatal-Perinatal Medicine Physician	ME65503	FL
3	208000000X	Pediatrics Physician	ME65503	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

General Provider Information

NPI Number	:	1821074683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARCO TULIO GONZALEZ MD

Provider Business Mailing Address
First Line	:	PO BOX 17540
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33318-7540
Country	:	US
Telephone Number	:	954-838-2371
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 NW 42ND AVE
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33317-2835
Country	:	US
Telephone Number	:	954-587-5010
Fax Number	:

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

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	05/29/2025

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Directions to “ DR. MARCO TULIO GONZALEZ MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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