Provider Demographics
NPI:1215903729
Name:TRILLO, CARLOS (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:
Last Name:TRILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 W COLONIAL DR
Mailing Address - Street 2:SUITE 393
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-3498
Mailing Address - Country:US
Mailing Address - Phone:407-296-1871
Mailing Address - Fax:407-296-1873
Practice Address - Street 1:10000 W COLONIAL DR
Practice Address - Street 2:SUITE 393
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-3498
Practice Address - Country:US
Practice Address - Phone:407-296-1871
Practice Address - Fax:407-296-1873
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67404208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257888300Medicaid
FL47259OtherBCBS NUMBER
FL47259OtherBCBS NUMBER
FL47259WMedicare PIN
FL47259ZMedicare ID - Type UnspecifiedLAKE COUNTY MEDICARE