Individual
MARCO TEODORO BOLOGNA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8950 N KENDALL DR STE 506W, MIAMI, FL 33176-2127
(786) 596-1230
(786) 533-9297
Mailing address
PO BOX 198054, ATLANTA, GA 30384-8054
(786) 594-6880
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
25242
AL
2086S0129X
Vascular Surgery Physician
ME97766
FL
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
ME97766
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009932702
—
AL
05
—
009932919
—
AL
01
—
010033CI37553
SECTION 1011
AL
01
—
02208294
MISSISSIPPI MEDICAID
MS
01
—
051530103
BLUE CROSS
AL
01
—
051530105
BLUE CROSS
AL
05
—
277690100
—
FL
Enumeration date
05/24/2006
Last updated
07/19/2022
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