Organization
BASIL C THEODOTOU MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BASIL THEODOTOU MD (OWNER)
(321) 752-7001
Entity
Organization
Contact information
Practice address
32 SUNTREE PL, MELBOURNE, FL 32940-7689
(321) 752-7001
(321) 254-1776
Mailing address
32 SUNTREE PL, MELBOURNE, FL 32940-7689
(321) 752-7001
(321) 254-1776
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
ME0046303
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
041713100
—
FL
Enumeration date
12/06/2011
Last updated
01/05/2017
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