Provider Demographics
NPI:1295290310
Name:FILOLI INC
Entity type:Organization
Organization Name:FILOLI INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANTON
Authorized Official - Middle Name:
Authorized Official - Last Name:FETKULOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-391-0269
Mailing Address - Street 1:434 SW 12TH AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-2432
Mailing Address - Country:US
Mailing Address - Phone:786-391-0269
Mailing Address - Fax:786-391-1694
Practice Address - Street 1:434 SW 12TH AVE STE 205
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-2432
Practice Address - Country:US
Practice Address - Phone:786-391-0269
Practice Address - Fax:786-391-1694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-02
Last Update Date:2019-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty