Provider Demographics
NPI:1285621243
Name:CARRILLO, ROGER G (MD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:G
Last Name:CARRILLO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1295 NW 14TH ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-1610
Mailing Address - Country:US
Mailing Address - Phone:305-689-2784
Mailing Address - Fax:305-689-2865
Practice Address - Street 1:1295 NW 14TH ST
Practice Address - Street 2:SUITE H
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1610
Practice Address - Country:US
Practice Address - Phone:305-689-2784
Practice Address - Fax:305-689-2865
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2013-04-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME45629208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
E73712Medicare UPIN