Provider Demographics
NPI:1659535987
Name:MARMOLEJOS, INDIRA M (MD)
Entity Type:Individual
Prefix:
First Name:INDIRA
Middle Name:M
Last Name:MARMOLEJOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6238 W ATLANTIC AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-3501
Mailing Address - Country:US
Mailing Address - Phone:561-404-9845
Mailing Address - Fax:561-404-9849
Practice Address - Street 1:6238 W ATLANTIC AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-3501
Practice Address - Country:US
Practice Address - Phone:561-404-9845
Practice Address - Fax:561-404-9849
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99093207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME99093OtherLICENSURE
FLCA955ZMedicare PIN