Provider Demographics
NPI:1548355217
Name:BLANCO, ADOLFO F (MD)
Entity type:Individual
Prefix:DR
First Name:ADOLFO
Middle Name:F
Last Name:BLANCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11255SW211TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33189-2240
Mailing Address - Country:US
Mailing Address - Phone:305-278-0200
Mailing Address - Fax:305-851-4110
Practice Address - Street 1:11255 SW 211TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33189-2240
Practice Address - Country:US
Practice Address - Phone:305-278-0200
Practice Address - Fax:786-235-0145
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67714208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377319100Medicaid
FL04362877OtherECFMG
FL04362877OtherECFMG
FLD63865Medicare UPIN
FL26794Medicare ID - Type Unspecified