Provider Demographics
NPI:1033408646
Name:MACAM, ROSANTO AGPAOA (MD)
Entity Type:Individual
Prefix:
First Name:ROSANTO
Middle Name:AGPAOA
Last Name:MACAM
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 1:1004 BEVERLY DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2840
Mailing Address - Country:US
Mailing Address - Phone:321-637-2949
Mailing Address - Fax:
Practice Address - Street 1:240 N WICKHAM RD
Practice Address - Street 2:SUITE 304
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-8662
Practice Address - Country:US
Practice Address - Phone:321-308-5060
Practice Address - Fax:321-984-9497
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL109849207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine