Provider Demographics
NPI:1578566477
Name:BADILLO, SALVADOR G (MD)
Entity Type:Individual
Prefix:DR
First Name:SALVADOR
Middle Name:G
Last Name:BADILLO
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 1:10330 N DALE MABRY HWY STE 190
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-4404
Mailing Address - Country:US
Mailing Address - Phone:813-963-7788
Mailing Address - Fax:813-443-8149
Practice Address - Street 1:10330 N DALE MABRY HWY
Practice Address - Street 2:STE 190
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-4404
Practice Address - Country:US
Practice Address - Phone:813-963-7788
Practice Address - Fax:813-443-8149
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61190208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251447800Medicaid
FLDJ415ZMedicare PIN
FLF75954Medicare UPIN