ANTONIO G. REVILLA JR., M.D. P.A. (NPI# 1548532088) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548532088 |
| Entity Type | Organization |
| Organization Name | ANTONIO G. REVILLA JR., M.D. P.A. |
| Practice Address |
1880 E Commercial Blvd Suite 3 Fort Lauderdale FL 33308-3747 |
| Practice Telephone | 9547720949 |
| Practice Fax Number | 9547720957 |
| Mailing Telephone | 9547720949 |
| Mailing Fax Number | 9547720957 |
| Enumeration Date | 2012-01-30 |
| Last Update Date | 2012-02-17 |
| Authorized Official Name | DR. ANTONIO G. REVILLA JR. (PRESIDENT) |
| Authorized Official Telephone | 9547720949 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | ME0021737 | FL | Allopathic & Osteopathic Physicians |
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
ME0021737 | FL | Allopathic & Osteopathic Physicians |
| Street Address |
1880 E COMMERCIAL BLVD SUITE 3 |
| City | FORT LAUDERDALE |
| State | FL |
| Zip Code | 33308-3747 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134150584 | Frank George Baratta | Specialist | 1880 E Commercial Blvd, Suite 1, Fort Lauderdale, FL 33308-3747 | 2006-07-05 |
| 1578809976 | Ronald M Tuttelman Mdpa | Obstetrics & Gynecology | 1880 E Commercial Blvd, Suite 4, Fort Lauderdale, FL 33308-3747 | 2012-12-13 |
| 1003026915 | Elite Cardiovascular Surgeons of South Florida | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1880 E Commercial Blvd, Suite 6, Fort Lauderdale, FL 33308-3747 | 2007-05-22 |
| 1407999592 | Ronald M Tuttelman | Obstetrics & Gynecology | 1880 E Commercial Blvd, Suite 4, Fort Lauderdale, FL 33308-3747 | 2007-02-15 |
| 1013934470 | Antonio G Revilla Jr. | Specialist | 1880 E Commercial Blvd, Suite 3, Fort Lauderdale, FL 33308-3747 | 2006-07-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215558788 | Marina Silva Ferreira | Student in an Organized Health Care Education/Training Program | Univ of Miami Miller School of Med Holy Cross Hospital, 4725 N Federal Highway, Fort Lauderdale, FL 33308 | 2020-05-06 |
| 1013538040 | Mehak Bansal | Student in an Organized Health Care Education/Training Program | 4725 N Federal Highway University of Miami, Miller School of Medicine Holy Cross Hospital Internal, Fort Lauderdale, FL 33308 | 2020-04-30 |
| 1285269266 | Roman Castell | Massage Therapist | 2480 E Commercial Blvd Ste 3, Fort Lauderdale, FL 33308 | 2020-03-10 |
| 1124667969 | Icarevip, Inc | Internal Medicine | 4800 N. Federal Highway, Suite 200, Fort Lauderdale, FL 33308 | 2019-12-26 |
| 1629612932 | Lana A Simmonds | Nurse Practitioner | 4390 N. Federal Hwy, Unit 101, Fort Lauderdale, FL 33308 | 2019-10-30 |
| 1063997260 | Kneaded Therapy, Inc | Physical Medicine & Rehabilitation | 2746 E Commerical Blvd., Ft. Lauderdale, FL 33308 | 2018-10-03 |
| 1518452184 | Colleen Lynn Culbertson | Nurse Anesthetist, Certified Registered | 1930 Ne 47th St Ste 308, Ft Lauderdale, FL 33308 | 2018-06-26 |
| 1962910562 | Healing Therapy Center Pllc | Social Worker | Healing Therapy, 1919 Ne 45th Street, Suite 225, Ft. Lauderale, FL 33308 | 2018-01-17 |
| 1376066647 | Carlos Jose Garcia | Student in an Organized Health Care Education/Training Program | 4725 North Federal Highway Suite 501, Fort Lauderdale, FL 33308 | 2017-07-19 |
| 1407381940 | Heather Hickson Lac LLC | Clinic/Center | 5353 North Federal Highway, Ste 220, Fort Lauderdale, FL 33308 | 2017-04-21 |
| Find all providers in zip 33308 | ||||
| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316413115 | Fox Vascular Experts, LLC | Surgery | 2699 Stirling Rd Ste A301302, Fort Lauderdale, FL 33312-6517 | 2018-10-18 |
| 1124172622 | Vasana Cheanvechai | Surgery | 4800 Ne 20th Ter Ste 109, Fort Lauderdale, FL 33308 | 2007-01-22 |
| 1588098669 | Palm Vascular Center of Broward, LLC | Surgery | 3109 Stirling Rd, Suite 100, Fort Lauderdale, FL 33312-6558 | 2013-08-26 |
| 1164743837 | Rafael Miguel Bustamante | Surgery | 1601 S Andrews Ave Fl 3, Fort Lauderdale, FL 33316-2509 | 2010-06-17 |
| 1174784433 | Joseph Hasan Habib | Surgery | 1601 S Andrews Ave Fl 3, Fort Lauderdale, FL 33316-2509 | 2008-06-19 |
| 1710995816 | Comprehensive Vein Clinic of South Florida LLC | Surgery | 1940 Ne 47th St, Suite 1, Fort Lauderdale, FL 33308-7711 | 2006-08-04 |
| 1306874342 | North Broward Hospital District | Surgery | 1601 S Andrews Ave Fl 3, Fort Lauderdale, FL 33316-2509 | 2006-06-29 |
| 1346205465 | Carl C Gill | Surgery | 1625 Se 3rd Ave, Third Floor, Fort Lauderdale, FL 33316 | 2006-04-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104394857 | George Scott Hall Sr. | Surgery | 9 Marsh Creek Rd, Fernandina Beach, FL 32034-6413 | 2018-11-09 |
| 1114417508 | Vascular Center of Naples Inc. | Surgery | 5490 Bryson Dr Ste 201, Naples, FL 34109 | 2018-05-11 |
| 1598267593 | Joseph D Stillword, Md | Surgery | 800 Zeagler Dr Ste 320, Palatka, FL 32177-3827 | 2018-03-06 |
| 1386157006 | Beatriz Lam | Surgery | 2001 West 68 St, Cvicu, Hialeah, FL 33016 | 2017-11-16 |
| 1811421092 | Sunrise Vascular Center | Surgery | 8555 Nw 165th Ter, Miami Lakes, FL 33016-6138 | 2017-04-14 |
| 1962891838 | Global Trauma Systems, Inc | Surgery | 126 Se Mira Lavella, Port Saint Lucie, FL 34984-6615 | 2015-01-15 |
| 1184013450 | Vas-q-lar, Inc | Surgery | 6187 Nw 167th St, Suite H13, Hialeah, FL 33015-4340 | 2015-01-09 |
| 1396147138 | Usa Vein Clinics of Miami, LLC | Surgery | 1711 E Hallandale Beach Blvd Ste B, Hallandale Beach, FL 33009-4621 | 2014-09-24 |
| 1114336021 | Florida Vein Center, Inc | Surgery | 6050 53rd Ave E Unit A, Bradenton, FL 34203-9700 | 2014-08-05 |
| 1528484516 | Rolando Sanchez | Surgery | 4039 W Kennedy Blvd, Tampa, FL 33609-2751 | 2014-03-14 |
| Find all providers with the same taxonomy | ||||
| City | FORT LAUDERDALE |
| Zip Code | 33308 |
Please comment or provide details below to improve the information on ANTONIO G. REVILLA JR., M.D. P.A..
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.