MEDICARE: ELEFTHERIOS P MAMOUNAS MD

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	35072102M	OH
2	2086X0206X	Surgical Oncology Physician	ME114413	FL
3	208600000X	Surgery Physician	ME114413	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	ME114413	OTHER	FL	MEDICAL LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174580492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELEFTHERIOS P MAMOUNAS MD

Provider Business Mailing Address
First Line	:	2501 N ORANGE AVE STE 389
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-4623
Country	:	US
Telephone Number	:	407-303-5214
Fax Number	:

Provider Business Practice Location Address
First Line	:	2501 N ORANGE AVE STE 389
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-4623
Country	:	US
Telephone Number	:	407-303-5214
Fax Number	:

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

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	05/13/2024

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