Theophelis, Lee G
Theophelis, Lee G is an sole proprietor health care provider with primary practice located at 1350 Hickory St , Melbourne FL 32901-3224. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Trauma Surgery, Allopathic & Osteopathic Physicians / Plastic and Reconstructive Surgery. Allopathic & Osteopathic Physicians / Plastic and Reconstructive Surgery is his primary health care specialty. Theophelis, Lee G can be contacted via phone (321) 434-1401.Contact Information
Primary practice address
1350 Hickory St
Melbourne FL 32901-3224
Phone: (321) 434-1401
Fax: (321) 434-1667
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Trauma Surgery | 2086S0127X | ME59792 | Florida |
| Allopathic & Osteopathic Physicians / Plastic and Reconstructive Surgery | 2086S0122X | ME59792 | Florida |
Profile Details
| NPI number | 1861448318 |
|---|---|
| LBN Legal business name | Theophelis, Lee G |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | May 26th, 2006 |
| Last updated | Nov 3rd, 2023 - about 2 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1861448318 | NPPES |
| Florida | Other | 18869W | FL MEDICARE |
| Florida | Other | 18869V | FL MEDICARE |
| Florida | MEDICAID | 372847100 | FL MEDICARE |
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