Provider Demographics
NPI:1174638027
Name:PADRO, ROLANDO B (MD)
Entity Type:Individual
Prefix:DR
First Name:ROLANDO
Middle Name:B
Last Name:PADRO
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 1:15439 SW 137TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-1279
Mailing Address - Country:US
Mailing Address - Phone:305-259-5570
Mailing Address - Fax:305-259-5533
Practice Address - Street 1:15439 SW 137TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-1279
Practice Address - Country:US
Practice Address - Phone:305-259-5570
Practice Address - Fax:305-259-5533
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66446208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL25616BMedicare ID - Type Unspecified
FLF89106Medicare UPIN
FL25616Medicare ID - Type Unspecified