Provider Demographics
NPI:1174829121
Name:INDIRA MARMOLEJOS MD PA
Entity Type:Organization
Organization Name:INDIRA MARMOLEJOS MD PA
Other - Org Name:PALM BEACH INFECTIOUS DISEASES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:INDIRA
Authorized Official - Middle Name:MARIBEL
Authorized Official - Last Name:MARMOLEJOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-404-9845
Mailing Address - Street 1:6238 W ATLANTIC AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-3501
Mailing Address - Country:US
Mailing Address - Phone:561-404-9845
Mailing Address - Fax:561-404-9849
Practice Address - Street 1:6238 W ATLANTIC AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-3501
Practice Address - Country:US
Practice Address - Phone:561-404-9845
Practice Address - Fax:561-404-9849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99093207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001469700Medicaid