MEDICARE: GEORGIS PATSIAS MD PA

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	208800000X	Urology Physician	ME0049282	FL

General Provider Information

NPI Number	:	1629096540
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGIS PATSIAS MD PA

Provider Business Mailing Address
First Line	:	1397 MEDICAL PARK BLVD
Second Line	:	SUITE 260
City	:	WELLINGTON
State	:	FL
Zip	:	33414-6108
Country	:	US
Telephone Number	:	561-753-3787
Fax Number	:	561-753-3793

Provider Business Practice Location Address
First Line	:	1397 MEDICAL PARK BLVD
Second Line	:	SUITE 260
City	:	WELLINGTON
State	:	FL
Zip	:	33414-6108
Country	:	US
Telephone Number	:	561-753-3787
Fax Number	:	561-753-3793

Authorized Official
Title or Position	:	OWNER
Name	:	GEORGIS PATISIAS
Credential	:	M.D.
Telephone Number	:	561-753-3787

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	08/15/2007

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