Provider Demographics
NPI:1881866796
Name:CARCACHE, LUIS MARCELO (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:MARCELO
Last Name:CARCACHE
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 1:800 SW 108TH AVENUE
Mailing Address - Street 2:STE 100
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174
Mailing Address - Country:US
Mailing Address - Phone:305-348-3627
Mailing Address - Fax:305-348-4621
Practice Address - Street 1:800 SW 108TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-2555
Practice Address - Country:US
Practice Address - Phone:305-348-3627
Practice Address - Fax:305-348-4621
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1106032084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008601600Medicaid