Provider Demographics
NPI:1871660506
Name:PAOLILLO, LOUIS M (M D)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:M
Last Name:PAOLILLO
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 JEFFORDS ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-4024
Mailing Address - Country:US
Mailing Address - Phone:727-446-9100
Mailing Address - Fax:727-446-9900
Practice Address - Street 1:1010 JEFFORDS ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-4024
Practice Address - Country:US
Practice Address - Phone:727-446-9100
Practice Address - Fax:727-446-9900
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43473207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD57462Medicare UPIN
FL62475Medicare ID - Type Unspecified