Provider Demographics
NPI:1982660106
Name:YOHANNES-PETERS, FITSUM (MD)
Entity Type:Individual
Prefix:DR
First Name:FITSUM
Middle Name:
Last Name:YOHANNES-PETERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 BRUCE B DOWNS BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-9207
Mailing Address - Country:US
Mailing Address - Phone:813-929-5590
Mailing Address - Fax:813-929-5596
Practice Address - Street 1:2600 BRUCE B DOWNS BLVD STE 102
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-9207
Practice Address - Country:US
Practice Address - Phone:813-929-5590
Practice Address - Fax:813-929-5596
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92187207PE0005X, 207P00000X, 207PH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
No207PH0002XAllopathic & Osteopathic PhysiciansEmergency MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272686600Medicaid
FLP00675105OtherRAILROAD MEDICARE PIN
FLP00280671OtherRAILROAD MEDICARE PIN
FL10050Medicare PIN
FL10050YMedicare PIN
FL10050ZMedicare PIN
FLP00675105OtherRAILROAD MEDICARE PIN
I33718Medicare UPIN
FL10050WMedicare PIN