Provider Demographics
NPI:1558449215
Name:DESROSIERS, MARIE-CAROLE (MD)
Entity type:Individual
Prefix:DR
First Name:MARIE-CAROLE
Middle Name:
Last Name:DESROSIERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3389 SHERIDAN ST
Mailing Address - Street 2:#423
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3606
Mailing Address - Country:US
Mailing Address - Phone:954-251-7469
Mailing Address - Fax:954-989-8703
Practice Address - Street 1:99 NW 183RD ST
Practice Address - Street 2:SUITE 117A
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-4502
Practice Address - Country:US
Practice Address - Phone:305-974-5848
Practice Address - Fax:305-974-5604
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME60806207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0596566-00Medicaid
FLF23766Medicare UPIN