Provider Demographics
NPI:1972518322
Name:EUGENIO M BRICIO MD PA
Entity type:Organization
Organization Name:EUGENIO M BRICIO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EUGENIO
Authorized Official - Middle Name:
Authorized Official - Last Name:BRICIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:305-932-3515
Mailing Address - Street 1:2999 NE 191ST ST
Mailing Address - Street 2:SUITE 330
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3123
Mailing Address - Country:US
Mailing Address - Phone:305-932-3515
Mailing Address - Fax:305-933-1473
Practice Address - Street 1:2999 NE 191ST ST
Practice Address - Street 2:SUITE 330
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3123
Practice Address - Country:US
Practice Address - Phone:305-932-3515
Practice Address - Fax:305-933-1473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271268700Medicaid
FL400001595000OtherPREFERRED CARE PARTNERS
FLK5520Medicare PIN