Provider Demographics
NPI:1033256268
Name:ALEJANDRO VILASUSO,M.D.P.A.
Entity Type:Organization
Organization Name:ALEJANDRO VILASUSO,M.D.P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:J
Authorized Official - Last Name:VILASUSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-325-0913
Mailing Address - Street 1:1400 NW 12TH AVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1003
Mailing Address - Country:US
Mailing Address - Phone:305-325-0913
Mailing Address - Fax:305-326-8661
Practice Address - Street 1:1400 NW 12TH AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1003
Practice Address - Country:US
Practice Address - Phone:305-325-0913
Practice Address - Fax:305-326-8661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0042999207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX IDENTIFICATION
FL=========OtherTAX IDENTIFICATION
FLD77106Medicare UPIN