Provider Demographics
NPI:1417259540
Name:MICHELINO SCARLATA MD
Entity Type:Organization
Organization Name:MICHELINO SCARLATA MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELINO
Authorized Official - Middle Name:
Authorized Official - Last Name:SCARLATA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-498-6377
Mailing Address - Street 1:5161 COLLINS AVE
Mailing Address - Street 2:APT 1609
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2755
Mailing Address - Country:US
Mailing Address - Phone:300-586-7191
Mailing Address - Fax:
Practice Address - Street 1:3801 BISCAYNE BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-9800
Practice Address - Country:US
Practice Address - Phone:305-571-0620
Practice Address - Fax:305-576-8099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-22
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME104846208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001349600Medicaid
FLCG680ZMedicare PIN