Provider Demographics
NPI:1629069950
Name:MAGGIOLO, LUIS F (MD)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:F
Last Name:MAGGIOLO
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 1:9090 SW 87TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2315
Mailing Address - Country:US
Mailing Address - Phone:305-444-2858
Mailing Address - Fax:305-448-3346
Practice Address - Street 1:9090 SW 87TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2315
Practice Address - Country:US
Practice Address - Phone:305-444-2858
Practice Address - Fax:305-448-3346
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME34116208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL066439100Medicaid
FL95922WMedicare ID - Type Unspecified
FL066439100Medicaid