Basic Information
| Provider Information | |||||||||
| NPI: | 1700866639 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARRILLO | ||||||||
| FirstName: | ANTONIO | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 29877 TELEGRAPH RD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480341332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2487992600 | ||||||||
| FaxNumber: | 2487992604 | ||||||||
| Practice Location | |||||||||
| Address1: | 29877 TELEGRAPH RD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480341332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2487992600 | ||||||||
| FaxNumber: | 2487992604 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 4301034822 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.