Provider Demographics
NPI:1902463383
Name:AMARANTE, MARCO T (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCO T
Middle Name:
Last Name:AMARANTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MARCO TULIO
Other - Middle Name:
Other - Last Name:JUNQUEIRA AMARANTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1300 PONCE DE LEON BLVD APT 1000
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-3364
Mailing Address - Country:US
Mailing Address - Phone:786-598-9616
Mailing Address - Fax:
Practice Address - Street 1:2500 NW 107TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-5923
Practice Address - Country:US
Practice Address - Phone:305-406-9055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME139769208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery