| Endoone Diabetes & Endocrinology Center, Llc | |
|
602 S Audubon Ave Ste A Tampa FL 33609-4217 | |
| (813) 931-2424 | |
| (813) 869-3148 |
| Full Name | Endoone Diabetes & Endocrinology Center, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 602 S Audubon Ave Ste A, Tampa, Florida |
| Authorized Official Name and Position | Gustavo Antonio Meyreles Chaljub (MD) |
| Authorized Official Contact | 8139312424 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Endoone Diabetes & Endocrinology Center, Llc 602 S Audubon Ave Ste A Tampa FL 33609-4217 Ph: () - | Endoone Diabetes & Endocrinology Center, Llc 602 S Audubon Ave Ste A Tampa FL 33609-4217 Ph: (813) 931-2424 |
| NPI Number | 1053188417 |
|---|---|
| Provider Enumeration Date | 12/06/2023 |
| Last Update Date | 08/22/2024 |
| Medicare PECOS PAC ID | 9335585694 |
|---|---|
| Medicare Enrollment ID | O20240308000615 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053188417 | NPI | - | NPPES |
| 121617900 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | (* (Not Available)) | Secondary |
| 261QM2500X | Clinic/center - Medical Specialty | (* (Not Available)) | Primary |
| Provider Name | Madeline Candelario-cosme |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1144595406 PECOS PAC ID: 7315219656 Enrollment ID: I20240213001879 |
| Provider Name | Gustavo Antonio Meyreles-chaljub |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1700325479 PECOS PAC ID: 2769819549 Enrollment ID: I20240308002001 |
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