MEDICARE: DR. HECTOR IVAN PALLAVICINI 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	174400000X	Specialist	ME38774	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	:	1992764831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HECTOR IVAN PALLAVICINI M.D.

Provider Business Mailing Address
First Line	:	3499 W 4TH AVE
Second Line	:	SUITE 201
City	:	HIALEAH
State	:	FL
Zip	:	33012-4333
Country	:	US
Telephone Number	:	305-558-0411
Fax Number	:	305-863-3802

Provider Business Practice Location Address
First Line	:	3499 W 4TH AVE
Second Line	:	SUITE 201
City	:	HIALEAH
State	:	FL
Zip	:	33012-4333
Country	:	US
Telephone Number	:	305-558-0411
Fax Number	:	305-863-3802

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

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	11/16/2010

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