Provider Demographics
NPI:1417939141
Name:FILIZZOLA, MARCELO J (MD)
Entity Type:Individual
Prefix:
First Name:MARCELO
Middle Name:J
Last Name:FILIZZOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5458 TOWN CENTER RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1089
Mailing Address - Country:US
Mailing Address - Phone:561-395-8699
Mailing Address - Fax:561-395-9268
Practice Address - Street 1:5458 TOWN CENTER RD
Practice Address - Street 2:SUITE 2
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1089
Practice Address - Country:US
Practice Address - Phone:561-395-8699
Practice Address - Fax:561-395-9268
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM20030176207R00000X
FLME97520174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H88654Medicare UPIN
345511204Medicare PIN