Mystakas, Fotis G

Mystakas, Fotis G is an individual health care provider with primary practice located at 912 Russell Dr , Lebanon PA 17042-7485. He recently has only one registered license in Allopathic & Osteopathic Physicians / Orthopaedic Surgery, which is considered as his primary health care specialty. Mystakas, Fotis G can be contacted via phone (717) 272-7971.

Contact Information

Primary practice address
912 Russell Dr Lebanon PA 17042-7485
Fax: (717) 272-1241
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Orthopaedic Surgery 207X00000X MD034196L Pennsylvania

Profile Details

NPI number 1114993334
LBN Legal business name Mystakas, Fotis G
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 27th, 2006
Last updated Mar 18th, 2016 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114993334 NPPES
Pennsylvania Other 127119 MEDICARE
Pennsylvania MEDICAID 000643495 MEDICARE

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