Provider Demographics
NPI:1174804413
Name:MOUSTOUKAS, MICHAEL JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:MOUSTOUKAS
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 1:6050 CATTLERIDGE BLVD
Mailing Address - Street 2:STE 201
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6028
Mailing Address - Country:US
Mailing Address - Phone:941-365-0655
Mailing Address - Fax:
Practice Address - Street 1:6050 CATTLERIDGE BLVD
Practice Address - Street 2:STE 201
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6028
Practice Address - Country:US
Practice Address - Phone:941-365-0655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME131187207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery