Provider Demographics
NPI:1912023631
Name:CARLOS A CONRADO M D P A
Entity Type:Organization
Organization Name:CARLOS A CONRADO M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:A
Authorized Official - Last Name:CONRADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:305-248-4877
Mailing Address - Street 1:151 NW 11TH ST
Mailing Address - Street 2:SUITE E102
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-4360
Mailing Address - Country:US
Mailing Address - Phone:305-248-4877
Mailing Address - Fax:305-245-1576
Practice Address - Street 1:151 NW 11TH ST
Practice Address - Street 2:SUITE E102
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4360
Practice Address - Country:US
Practice Address - Phone:305-248-4877
Practice Address - Fax:305-245-1576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0061233207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267644300Medicaid
FL18453OtherBLUE CROSS BLUE SHIELD
FLF50302Medicare UPIN
FL18453AMedicare ID - Type Unspecified