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NPI Code Detail

MEDICARE: LUIS EDUARDO CARRILLO M.D.

MEDICARE: LUIS EDUARDO CARRILLO 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
1207RC0000XCardiovascular Disease PhysicianME73042FL
2207RC0001XClinical Cardiac Electrophysiology PhysicianME73042FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1821092370
Entity Type Code : Individual
Provider Name (Legal Business Name) : LUIS EDUARDO CARRILLO M.D.
Provider Business Mailing Address
First Line : 1324 LAKELAND HILLS BLVD
Second Line : ATTN MEDICAL STAFF OFFICE
City : LAKELAND
State : FL
Zip : 33805-4543
Country : US
Telephone Number : 863-284-1611
Fax Number :
Provider Business Practice Location Address
First Line : 130 PABLO ST
Second Line :
City : LAKELAND
State : FL
Zip : 33803-3818
Country : US
Telephone Number : 863-284-5941
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2005
Last Update Date : 07/10/2014

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Directions to “ LUIS EDUARDO CARRILLO M.D.” Practice Location

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