Provider Demographics
NPI:1225027782
Name:QUIROS, MARIO I (MD)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:I
Last Name:QUIROS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 S PINE ISLAND RD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3920
Mailing Address - Country:US
Mailing Address - Phone:305-821-8611
Mailing Address - Fax:305-827-1753
Practice Address - Street 1:16250 NW 57TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-6711
Practice Address - Country:US
Practice Address - Phone:786-442-2136
Practice Address - Fax:305-823-0914
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2022-06-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME59718208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023688100Medicaid