Provider Demographics
NPI:1114125630
Name:CABREIRA, ANTONIO PICACHE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:PICACHE
Last Name:CABREIRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2740 LAKE HOWELL LN
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-5716
Mailing Address - Country:US
Mailing Address - Phone:407-657-8104
Mailing Address - Fax:407-657-8104
Practice Address - Street 1:2740 LAKE HOWELL LN
Practice Address - Street 2:483 N. SEMORAN BLVD SUITE 103
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-5716
Practice Address - Country:US
Practice Address - Phone:407-215-6371
Practice Address - Fax:132-127-4032
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 27631207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD55488Medicare UPIN