MEDICARE: DR. STAVROS PAPANDREOU 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	207P00000X	Emergency Medicine Physician	OS12147	FL

General Provider Information

NPI Number	:	1518282714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STAVROS PAPANDREOU D.O.

Provider Business Mailing Address
First Line	:	4109 N FEDERAL HWY
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-5530
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4109 N FEDERAL HWY
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-5530
Country	:	US
Telephone Number	:	954-563-2707
Fax Number	:

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

Provider Enumeration Date	:	03/30/2010
Last Update Date	:	03/25/2014

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