MEDICARE: DR. GEORGE PETER TAVOULAREAS D.O.

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	2084N0400X	Neurology Physician	5101025740	MI
2	2084N0008X	Neuromuscular Medicine (Psychiatry & Neurology) Physician	036154523	IL
3	2084N0008X	Neuromuscular Medicine (Psychiatry & Neurology) Physician	02006261A	IN
4	2084N0400X	Neurology Physician	25MB10956800	NJ
5	2084N0400X	Neurology Physician	67106	CT
6	2084N0400X	Neurology Physician	20A18544	CA
7	2084N0400X	Neurology Physician	73913-21	WI
8	2084N0400X	Neurology Physician	200566	NY

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

General Provider Information

NPI Number	:	1427058858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE PETER TAVOULAREAS D.O.

Provider Business Mailing Address
First Line	:	163 77TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-2903
Country	:	US
Telephone Number	:	917-763-4921
Fax Number	:

Provider Business Practice Location Address
First Line	:	7402 HOLLISTER AVE
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93117-2583
Country	:	US
Telephone Number	:	805-562-8686
Fax Number	:

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	12/21/2021

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Directions to “ DR. GEORGE PETER TAVOULAREAS D.O.” Practice Location

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