Provider Demographics
NPI:1851340798
Name:CHAMIZO, WILFREDO (MD)
Entity Type:Individual
Prefix:DR
First Name:WILFREDO
Middle Name:
Last Name:CHAMIZO
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 1:801 6TH ST S
Mailing Address - Street 2:DEPT 7010
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4816
Mailing Address - Country:US
Mailing Address - Phone:727-767-4341
Mailing Address - Fax:727-767-8516
Practice Address - Street 1:801 6TH ST S
Practice Address - Street 2:DEPT 7010
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4816
Practice Address - Country:US
Practice Address - Phone:727-767-4341
Practice Address - Fax:727-767-8516
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME55082207ZI0100X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207ZI0100XAllopathic & Osteopathic PhysiciansPathologyImmunopathology
Not Answered207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF99888Medicare UPIN