Provider Demographics
NPI:1164415667
Name:PAPAPANOS, PETE (MD)
Entity Type:Individual
Prefix:MR
First Name:PETE
Middle Name:
Last Name:PAPAPANOS
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 1:1815 S KANNER HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994
Mailing Address - Country:US
Mailing Address - Phone:772-288-2992
Mailing Address - Fax:772-288-2999
Practice Address - Street 1:1815 S KANNER HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994
Practice Address - Country:US
Practice Address - Phone:772-288-2992
Practice Address - Fax:772-288-2999
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301070188207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4894591Medicaid
MI0F376970OtherBCBSM
MI0F376970OtherBCBSM
H49394Medicare UPIN