Provider Demographics
NPI:1164464020
Name:CONRADO, CARLOS A (MD,)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:A
Last Name:CONRADO
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 1:1400 NW 107TH AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2746
Mailing Address - Country:US
Mailing Address - Phone:305-534-0076
Mailing Address - Fax:
Practice Address - Street 1:151 NW 11TH ST
Practice Address - Street 2:SUITE E102
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4360
Practice Address - Country:US
Practice Address - Phone:305-248-4877
Practice Address - Fax:305-245-1576
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0061233207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267644300Medicaid
FL18453OtherBLUE CROSS BLUE SHIELD
FL267644300Medicaid
FL18453OtherBLUE CROSS BLUE SHIELD