Basic Information
| Provider Information | |||||||||
| NPI: | 1538283502 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MITROPOULOS | ||||||||
| FirstName: | PANAGIOTIS | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 151 SOUTHHALL LN | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | MAITLAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327517176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078752080 | ||||||||
| FaxNumber: | 4076503455 | ||||||||
| Practice Location | |||||||||
| Address1: | 2893 ENTERPRISE RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | DEBARY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327132784 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3867898600 | ||||||||
| FaxNumber: | 3867890219 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2007 | ||||||||
| LastUpdateDate: | 01/27/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | OS10931 | FL | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.