Healthcare Provider Details

I. General information

NPI: 1013203173
Provider Name (Legal Business Name): ELIAS TZELEPIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2011
Last Update Date: 01/01/2025
Certification Date: 01/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

312 S ELM ST
MOUNT PROSPECT IL
60056-3369
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-6969
  • Fax:
Mailing address:
  • Phone: 215-987-9323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT198869
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number036.134975
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME165370
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: