# LUIS E CARRILLO MD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891187027
- **Authorized official:** DR. LUIS ENRIQUE CARRILLO M.D. (OWNER)
- **Authorized official phone:** (863) 534-8436

## Contact information

- **Practice address:** 2200 OSPREY BLVD, SUITE 103, BARTOW, FL 33830-3308
- **Practice address phone:** (863) 534-8436
- **Practice address fax:** (863) 534-8005
- **Mailing address:** PO BOX 7097, LAKELAND, FL 33807-7097
- **Mailing address phone:** (863) 534-8436
- **Mailing address fax:** (863) 534-8005

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2083P0011X | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician | ME16832 | FL | Yes |

## Other

- **Enumeration date:** 02/25/2015
- **Last updated:** 02/25/2015