Healthcare Provider Details

I. General information

NPI: 1427013218
Provider Name (Legal Business Name): ANDREAS G. TZAKIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 02/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE BOX 016960 M851
MIAMI FL
33136-1005
US

IV. Provider business mailing address

1611 NW 12TH AVE BOX 016960 M851
MIAMI FL
33136-1005
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-1288
  • Fax: 305-243-8740
Mailing address:
  • Phone: 305-585-1288
  • Fax: 305-243-8740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License NumberME70382
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: