Provider Demographics
NPI:1669660908
Name:CHRISTOPHER J MAVROIDES MD PA
Entity type:Organization
Organization Name:CHRISTOPHER J MAVROIDES MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAVROIDES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-763-5666
Mailing Address - Street 1:1713 HWY 441 N
Mailing Address - Street 2:SUITE A
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972-1900
Mailing Address - Country:US
Mailing Address - Phone:863-763-5666
Mailing Address - Fax:863-763-0121
Practice Address - Street 1:1713 HWY 441 N
Practice Address - Street 2:SUITE A
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-1900
Practice Address - Country:US
Practice Address - Phone:863-763-5666
Practice Address - Fax:863-763-0121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061299501Medicaid
FL110164184OtherRAIL ROAD MEDICARE
FL09288OtherBCBS
FLK0667Medicare PIN
FL110164184OtherRAIL ROAD MEDICARE