Individual
LUIS EDUARDO CARRILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
130 PABLO ST, LAKELAND, FL 33803-3818
(863) 284-5941
Mailing address
1324 LAKELAND HILLS BLVD, ATTN MEDICAL STAFF OFFICE, LAKELAND, FL 33805-4543
(863) 284-1611
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
ME73042
FL
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
ME73042
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
252921100
—
FL
Enumeration date
06/10/2005
Last updated
07/10/2014
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