MEDICARE: DR. ZISSIS VESOULIS 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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	35-062217V	OH
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	159909	NY
3	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	4301084989	MI
4	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	MD030781E	PA

General Provider Information

NPI Number	:	1659356475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ZISSIS VESOULIS MD

Provider Business Mailing Address
First Line	:	7111 FAIRWAY DR
Second Line	:	SUITE 400
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-4204
Country	:	US
Telephone Number	:	561-712-7335
Fax Number	:	561-712-7349

Provider Business Practice Location Address
First Line	:	7730 FIRST PL
Second Line	:	SUITE A
City	:	OAKWOOD VILLAGE
State	:	OH
Zip	:	44146-6719
Country	:	US
Telephone Number	:	800-331-7546
Fax Number	:	440-703-2155

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

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	07/08/2007

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Directions to “ DR. ZISSIS VESOULIS MD” Practice Location

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