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General NPI Number Information
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NPI Number | 1487856563
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Entity Type | Individual
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Provider Name | GEORGE MICHAEL PANAGAKOS M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 09/14/2009
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Provider Practice Location Address
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Address Line | 1611 NW 12TH AVE
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City | MIAMI
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State | FL
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Zip | 33136-1005
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Country | US
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Telephone | 305-585-7878
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 BRICKELL BAY DR #2819
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City | MIAMI
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State | FL
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Zip | 33131-3251
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Country | US
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Telephone | 727-644-2641
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207U00000X
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Taxonomy Name | Nuclear Medicine Physician
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License Number | ME 97615
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME 97615
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License Number State | FL
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