Provider Demographics
NPI:1588860258
Name:VITIELLO, MARCO N (MD)
Entity Type:Individual
Prefix:
First Name:MARCO
Middle Name:N
Last Name:VITIELLO
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 1:7775 SW 87TH AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173
Mailing Address - Country:US
Mailing Address - Phone:305-661-0181
Mailing Address - Fax:305-661-0407
Practice Address - Street 1:7775 SW 87TH AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173
Practice Address - Country:US
Practice Address - Phone:305-661-0181
Practice Address - Fax:305-661-0407
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0038819207R00000X
CAG87098207R00000X
NY229517-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD63639Medicare UPIN
95854Medicare ID - Type Unspecified