Individual
DIMITRIOS HATZIVLASSIOU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, PHD
Contact information
Practice address
2400 S HWY 27, SUITE 4309, CLERMONT, FL 34711-6816
(352) 353-0557
Mailing address
2400 S HWY 27, SUITE 4309, CLERMONT, FL 34711-6816
(352) 353-0557
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
ME 84252
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03387
BLUE CROSS BLUE SHIELD #
FL
05
—
267232400
—
FL
Enumeration date
04/12/2006
Last updated
03/07/2023
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