Basic Information
Provider Information
NPI: 1720014848
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CARALIS
FirstName: PANAGIOTA
MiddleName: V
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1611 NW 12TH AVE
Address2: BOX 016960 M851
City: MIAMI
State: FL
PostalCode: 331361005
CountryCode: US
TelephoneNumber: 3052434664
FaxNumber: 3052438470
Practice Location
Address1: 1611 NW 12TH AVE
Address2: BOX 016960 M851
City: MIAMI
State: FL
PostalCode: 331361005
CountryCode: US
TelephoneNumber: 3052434664
FaxNumber: 3052438470
Other Information
ProviderEnumerationDate: 06/23/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XME30204FLX Allopathic & Osteopathic PhysiciansInternal Medicine 
208M00000XME30204FLX Allopathic & Osteopathic PhysiciansHospitalist 

No ID Information.


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