MEDICARE: CHARLES S. THEOFILOS 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	207T00000X	Neurological Surgery Physician	XXXXXXXXXXXXXXXX	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	23144	OTHER	FL	INDIVIDUAL MEDICARE NUMBE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841242823
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES S. THEOFILOS MD PA

Provider Business Mailing Address
First Line	:	300 VILLAGE SQUARE XING STE 202
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-3223
Country	:	US
Telephone Number	:	561-630-3870
Fax Number	:	561-630-3680

Provider Business Practice Location Address
First Line	:	300 VILLAGE SQUARE XING STE 202
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-3223
Country	:	US
Telephone Number	:	561-630-3870
Fax Number	:	561-630-3680

Authorized Official
Title or Position	:	PHYSICIAN OWNER
Name	:	CHARLES S THEOFILOS
Credential	:
Telephone Number	:	561-630-3870

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	04/28/2021

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Directions to “CHARLES S. THEOFILOS MD PA ” Practice Location

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