MEDICARE: GEORGE GEORGAKAKIS M.D. P.A.

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	207Y00000X	Otolaryngology Physician	ME82034	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51006	OTHER	FL	MEDICARE PPAN

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	:	1982909537
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGE GEORGAKAKIS M.D. P.A.

Provider Business Mailing Address
First Line	:	4801 N FEDERAL HWY
Second Line	:	SUITE 302
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4618
Country	:	US
Telephone Number	:	954-493-8773
Fax Number	:	954-493-8807

Provider Business Practice Location Address
First Line	:	4801 N FEDERAL HWY
Second Line	:	SUITE 302
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4618
Country	:	US
Telephone Number	:	954-493-8773
Fax Number	:	954-493-8807

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. GEORGE GEORGAKAKIS
Credential	:	M.D.
Telephone Number	:	954-493-8807

Provider Enumeration Date	:	01/12/2011
Last Update Date	:	01/12/2011

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