Provider Demographics
NPI:1235182494
Name:CORRALES, CARLOS F (DO)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:F
Last Name:CORRALES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16855 NE 2ND AVE
Mailing Address - Street 2:SUITE 302 A
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-1744
Mailing Address - Country:US
Mailing Address - Phone:305-653-8566
Mailing Address - Fax:305-653-4055
Practice Address - Street 1:16855 NE 2ND AVE
Practice Address - Street 2:SUITE 302 A
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-1744
Practice Address - Country:US
Practice Address - Phone:305-653-8566
Practice Address - Fax:305-653-4055
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 2969207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE96454Medicare UPIN
FL81940Medicare PIN