Provider Demographics
NPI:1417120247
Name:COLOMBO, ROSARIO ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSARIO
Middle Name:ANTONIO
Last Name:COLOMBO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RUSS
Other - Middle Name:ANTONIO
Other - Last Name:COLOMBO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1801 NW 9TH AVE
Mailing Address - Street 2:SUITE #209
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1101
Mailing Address - Country:US
Mailing Address - Phone:786-466-8490
Mailing Address - Fax:305-573-6562
Practice Address - Street 1:1801 NW 9TH AVE
Practice Address - Street 2:SUITE #209
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1101
Practice Address - Country:US
Practice Address - Phone:786-466-8490
Practice Address - Fax:305-573-6562
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-13
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME119835207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine