Provider Demographics
NPI:1083606214
Name:VADILLO, ALBERTO EUSEBIO (MD)
Entity Type:Individual
Prefix:
First Name:ALBERTO
Middle Name:EUSEBIO
Last Name:VADILLO
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:PO BOX 816759
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33081-0759
Mailing Address - Country:US
Mailing Address - Phone:305-674-1233
Mailing Address - Fax:954-964-6084
Practice Address - Street 1:4300 ALTON RD
Practice Address - Street 2:SUITE 2220
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2948
Practice Address - Country:US
Practice Address - Phone:305-674-2533
Practice Address - Fax:305-538-2960
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44119207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
060056769OtherPALMETTO GBA
FL064487100Medicaid
FL05790Medicare ID - Type Unspecified