Provider Demographics
NPI:1659356475
Name:VESOULIS, ZISSIS (MD)
Entity Type:Individual
Prefix:DR
First Name:ZISSIS
Middle Name:
Last Name:VESOULIS
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 1:7111 FAIRWAY DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-4204
Mailing Address - Country:US
Mailing Address - Phone:561-712-7335
Mailing Address - Fax:561-712-7349
Practice Address - Street 1:7730 FIRST PL
Practice Address - Street 2:SUITE A
Practice Address - City:OAKWOOD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44146-6719
Practice Address - Country:US
Practice Address - Phone:800-331-7546
Practice Address - Fax:440-703-2155
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-062217V207ZP0102X
NY159909207ZP0102X
MI4301084989207ZP0102X
PAMD030781E207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B36206Medicare UPIN