Provider Demographics
NPI:1174918023
Name:BAKHOS, KATERINA (MD)
Entity type:Individual
Prefix:
First Name:KATERINA
Middle Name:
Last Name:BAKHOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATERINA
Other - Middle Name:
Other - Last Name:PORCARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2845 AVENTURA BLVD STE 245
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3120
Mailing Address - Country:US
Mailing Address - Phone:053-692-1072
Mailing Address - Fax:305-692-1073
Practice Address - Street 1:2845 AVENTURA BLVD STE 245
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3120
Practice Address - Country:US
Practice Address - Phone:305-692-1072
Practice Address - Fax:305-692-1073
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME151119207RC0000X
IL036.145965207RC0000X
IL125066523207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine