Provider Demographics
NPI:1780991992
Name:ISIDOROS J MORAITIS MD PA
Entity type:Organization
Organization Name:ISIDOROS J MORAITIS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ISIDOROS
Authorized Official - Middle Name:
Authorized Official - Last Name:MORAITIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-773-9796
Mailing Address - Street 1:3890 TAMPA RD
Mailing Address - Street 2:SUITE 406
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3676
Mailing Address - Country:US
Mailing Address - Phone:727-773-9796
Mailing Address - Fax:
Practice Address - Street 1:3890 TAMPA RD
Practice Address - Street 2:SUITE 406
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3676
Practice Address - Country:US
Practice Address - Phone:727-773-9796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86072208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265583700Medicaid
FLH47817Medicare UPIN
FL62710Medicare PIN