Provider Demographics
NPI:1700817574
Name:MARILL, CARLOS MIGUEL (MD, PA)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:MIGUEL
Last Name:MARILL
Suffix:
Gender:M
Credentials:MD, PA
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Mailing Address - Street 1:5975 SUNSET DRIVE
Mailing Address - Street 2:PENTHOUSE 802
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143
Mailing Address - Country:US
Mailing Address - Phone:786-497-2880
Mailing Address - Fax:786-497-2881
Practice Address - Street 1:6280 SUNSET DR STE 400
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4860
Practice Address - Country:US
Practice Address - Phone:786-497-2880
Practice Address - Fax:786-497-2881
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2020-05-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME44925207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD20753Medicare UPIN