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1164642096

NPI Code Detail

MEDICARE: DR. GEORGIOS HATZOUDIS M.D.

MEDICARE: DR. GEORGIOS HATZOUDIS M.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	208600000X	Surgery Physician	ME144433	FL
2	208600000X	Surgery Physician	261793	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00451957	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1701924	OTHER	SD	MEDICA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	4992486	OTHER	SD	BLUE CROSS SOUTH DAKOTA
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	370624200	OTHER	SD	DEPT OF LABOR
8	412871051724	OTHER	SD	PREFERRED ONE
9	1164642096	OTHER	SD	ARAZ/ AMERICA'S PPO
10	253814	OTHER	SD	MIDLANDS CHOICE
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	7054	OTHER	SD	DAKOTACARE
13	HP79711	OTHER		HEALTHPARTNERS
14	70L87HA	OTHER	MN	BLUE CROSS
15	70L87HA	OTHER	MN	CC SYSTEMS/ BLUE PLUS
16	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164642096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGIOS HATZOUDIS M.D.

Provider Business Mailing Address
First Line	:	500 W SAGAMORE AVE
Second Line	:
City	:	CLEWISTON
State	:	FL
Zip	:	33440-3514
Country	:	US
Telephone Number	:	863-983-3434
Fax Number	:	863-983-2139

Provider Business Practice Location Address
First Line	:	1138 BROADWAY ST
Second Line	:
City	:	ELMIRA
State	:	NY
Zip	:	14904-2502
Country	:	US
Telephone Number	:	607-734-2695
Fax Number	:	607-734-2917

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	05/22/2020

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Directions to “ DR. GEORGIOS HATZOUDIS M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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