Provider Demographics
NPI:1457457681
Name:MEKRAS, JOHN ARISTEDES (MD,PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ARISTEDES
Last Name:MEKRAS
Suffix:
Gender:M
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7051 SW 62ND AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4701
Mailing Address - Country:US
Mailing Address - Phone:305-661-8977
Mailing Address - Fax:305-662-9123
Practice Address - Street 1:7051 SW 62ND AVE
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4701
Practice Address - Country:US
Practice Address - Phone:305-661-8977
Practice Address - Fax:305-662-9123
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0061974208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15056OtherBLUE CROSS AND BLUE SHIEL
95151WMedicare ID - Type Unspecified
FLF28639Medicare UPIN