Provider Demographics
NPI:1083015416
Name:HUGO LLANES MD PA
Entity Type:Organization
Organization Name:HUGO LLANES MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HUGO
Authorized Official - Middle Name:
Authorized Official - Last Name:LLANES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-322-4648
Mailing Address - Street 1:1275 W 47TH PL
Mailing Address - Street 2:SUITE 307
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3394
Mailing Address - Country:US
Mailing Address - Phone:305-631-6840
Mailing Address - Fax:305-631-6894
Practice Address - Street 1:1275 W 47TH PL
Practice Address - Street 2:SUITE 307
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3394
Practice Address - Country:US
Practice Address - Phone:305-631-6840
Practice Address - Fax:305-631-6894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0068077207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG06837Medicare PIN