Provider Demographics
NPI:1174580492
Name:MAMOUNAS, ELEFTHERIOS P (MD)
Entity type:Individual
Prefix:
First Name:ELEFTHERIOS
Middle Name:P
Last Name:MAMOUNAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 N ORANGE AVE STE 389
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4623
Mailing Address - Country:US
Mailing Address - Phone:407-303-5214
Mailing Address - Fax:
Practice Address - Street 1:2501 N ORANGE AVE STE 389
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4623
Practice Address - Country:US
Practice Address - Phone:407-303-5214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35072102M208600000X
FLME1144132086X0206X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0962490Medicaid
FLME114413OtherMEDICAL LICENSE
FL007147900Medicaid
OH0962490Medicaid
FLME114413OtherMEDICAL LICENSE