Provider Demographics
NPI:1467493585
Name:GRANADOS, CARLOS TEOFILO (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:TEOFILO
Last Name:GRANADOS
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 1:4716 WEST FLAGLER ST.
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1452
Mailing Address - Country:US
Mailing Address - Phone:305-774-6550
Mailing Address - Fax:305-774-0499
Practice Address - Street 1:4716 WEST FLAGLER ST.
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33134-1452
Practice Address - Country:US
Practice Address - Phone:305-774-6550
Practice Address - Fax:305-774-0499
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67716207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377311601Medicaid
26536Medicare PIN
FL377311601Medicaid