Ian A Concilio, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

ME 78360 Issued in FL

Practice address

1646 NE 7TH Ave
Fort Lauderdale, FL 33305-3028

Phone

(772) 618-5527

NPI assigned

Sep 2, 2006

Sex

Male

Sole proprietor

Yes

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• American Mane LLC

  • Clinic/Center
  • Aventura, FL
  • NPI 1316613615
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 14, 2025.

{
    "created_epoch": "1157155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741910400000",
    "number": "1386746063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1646 NE 7TH AVE",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333053028",
            "telephone_number": "772-618-5527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1646 NE 7TH AVE",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333053028",
            "telephone_number": "772-618-5527"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "701 W Hallandale Beach Blvd Fl 33009",
            "address_purpose": "LOCATION",
            "city": "Hallandale Beach",
            "state": "FL",
            "postal_code": "330095327",
            "country_code": "US",
            "telephone_number": "954-458-8007",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2801 NE 213th St Ste 1111",
            "address_purpose": "LOCATION",
            "city": "Aventura",
            "state": "FL",
            "postal_code": "331801267",
            "country_code": "US",
            "telephone_number": "954-895-4707",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "21110 Biscayne Blvd Ste 406",
            "address_purpose": "LOCATION",
            "city": "Aventura",
            "state": "FL",
            "postal_code": "331801252",
            "country_code": "US",
            "telephone_number": "305-727-4247",
            "fax_number": "954-820-7285",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CONCILIO",
        "first_name": "IAN",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-02",
        "last_updated": "2025-03-14",
        "certification_date": "2025-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "FL",
            "license": "ME 78360",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "277068700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Concentra
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• Concentra Health Services, Inc.
• Concentra Health Services, Inc.
• Concierge Aesthetics, LLC
• Conference of Christian Pastors and Ministers, Inc
• Kelley A Conley, P.T.
• Lara Conley, LCSW
• Connections Therapy LLC
• Madison Virginia Conner

• All providers in Fort Lauderdale, FL
• Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.