Provider Demographics
NPI:1750470316
Name:GEORGAKAKIS, GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:GEORGAKAKIS
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 1:4801 NORTH FEDERAL HWY
Mailing Address - Street 2:STE #302
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308
Mailing Address - Country:US
Mailing Address - Phone:954-493-8773
Mailing Address - Fax:954-493-8807
Practice Address - Street 1:4801 NORTH FEDERAL HWY
Practice Address - Street 2:STE #302
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308
Practice Address - Country:US
Practice Address - Phone:954-493-8773
Practice Address - Fax:954-493-8807
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82034207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
001333308000OtherTRICARE
P00069954OtherRR MEDICARE
001333308000OtherTRICARE
P00069954OtherRR MEDICARE