Healthcare Provider Details

I. General information

NPI: 1457457681
Provider Name (Legal Business Name): JOHN ARISTEDES MEKRAS M.D.,P.H.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 11/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7051 SW 62ND AVE
SOUTH MIAMI FL
33143-4701
US

IV. Provider business mailing address

7051 SW 62ND AVE
SOUTH MIAMI FL
33143-4701
US

V. Phone/Fax

Practice location:
  • Phone: 305-661-8977
  • Fax: 305-662-9123
Mailing address:
  • Phone: 305-661-8977
  • Fax: 305-662-9123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME0061974
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: