Provider Demographics
NPI:1134235195
Name:MACEDO, FILHO, JOAO R (MD)
Entity type:Individual
Prefix:
First Name:JOAO
Middle Name:R
Last Name:MACEDO, FILHO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOAOROBERTO
Other - Middle Name:C
Other - Last Name:MACEDOFILHO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:225 SE 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-5436
Mailing Address - Country:US
Mailing Address - Phone:954-933-1376
Mailing Address - Fax:954-933-1376
Practice Address - Street 1:225 SE 28TH AVE
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-5436
Practice Address - Country:US
Practice Address - Phone:954-933-1376
Practice Address - Fax:954-933-1376
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22079512085R0202X
MI43010709952085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H48059Medicare UPIN
NY510S51Medicare ID - Type Unspecified