Healthcare Provider Details

I. General information

NPI: 1982607289
Provider Name (Legal Business Name): ATHANASSIOS I TSOUKAS M.D., FACS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 N KENDALL DR STE 504W
MIAMI FL
33176-2127
US

IV. Provider business mailing address

PO BOX 198054
ATLANTA GA
30384-8054
US

V. Phone/Fax

Practice location:
  • Phone: 305-274-2030
  • Fax: 786-533-7053
Mailing address:
  • Phone: 786-662-7980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME77299
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: