Provider Demographics
NPI:1609878859
Name:BRILLANTES, MIGUEL B (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:B
Last Name:BRILLANTES
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:200 MILL ROAD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5252
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:1565 NORTH MAIN STREET
Practice Address - Street 2:SUITE 306
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-2972
Practice Address - Country:US
Practice Address - Phone:508-973-9500
Practice Address - Fax:508-973-0351
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2020-04-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA154081207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110059156AMedicaid
MAA2298605Medicare PIN
MA3173143Medicaid