Provider Demographics
NPI:1700866639
Name:CARRILLO, ANTONIO P (MD)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:P
Last Name:CARRILLO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:29877 TELEGRAPH RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1332
Mailing Address - Country:US
Mailing Address - Phone:248-799-2600
Mailing Address - Fax:248-799-2604
Practice Address - Street 1:29877 TELEGRAPH RD
Practice Address - Street 2:SUITE 400
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1332
Practice Address - Country:US
Practice Address - Phone:248-799-2600
Practice Address - Fax:248-799-2604
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MI4301034822207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
E21142Medicare UPIN