MEDICARE: JOHN C MAVROPOULOS M.D., M.P.H., PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ND0101X	MOHS-Micrographic Surgery Physician	ME 124728	FL

General Provider Information

NPI Number	:	1063737682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN C MAVROPOULOS M.D., M.P.H., PH.D.

Provider Business Mailing Address
First Line	:	2121 S HIAWASSEE RD APT 4601
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-8768
Country	:	US
Telephone Number	:	443-435-3517
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 S HIAWASSEE RD APT 4601
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-8768
Country	:	US
Telephone Number	:	443-435-3517
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2010
Last Update Date	:	01/09/2025

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