Individual
DR. CONSTANTINE MAVROUDIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2501 N. ORANGE AVE, SUITE 450, ORLANDO, FL 32804
(407) 303-3692
(407) 303-3634
Mailing address
2501 N. ORANGE AVE, SUITE 450, ORLANDO, FL 32804
(407) 303-3692
(407) 303-3634
Taxonomy
Speciality
Code
Description
License number
State
2086S0120X
Pediatric Surgery Physician
35-092453
OH
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
ME112169
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004570600
—
FL
05
—
036079315
—
IL
01
—
1627123
BCBS PROVIDER ID
IL
05
—
2865896
—
OH
05
—
64213531
—
KY
05
—
CSF715
—
WV
05
—
XPY198252
—
CA
Enumeration date
09/16/2005
Last updated
04/04/2013
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