Healthcare Provider Details

I. General information

NPI: 1861553794
Provider Name (Legal Business Name): ATHENA PEFKAROU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 04/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SW 62 AVE NORTH EAST WING, SUITE 121
MIAMI FL
33155
US

IV. Provider business mailing address

5955 PONCE DE LEON BLVD
CORAL GABLES FL
33146
US

V. Phone/Fax

Practice location:
  • Phone: 305-662-8360
  • Fax: 305-666-6387
Mailing address:
  • Phone: 305-661-1515
  • Fax: 305-662-3723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberME0031878
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: