DR. LEE G THEOPHELIS (NPI# 1861448318) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861448318 |
| Entity Type | Individual |
| Full Name | DR. LEE G THEOPHELIS |
| Credential | MD |
| Practice Address |
1350 Hickory St Ste 101 Melbourne FL 32901-3224 |
| Mailing Address |
3300 S Fiske Blvd Rockledge FL 32955-4306 |
| Practice Telephone | 3214341401 |
| Practice Fax Number | 3214341667 |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2020-03-12 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0122X |
Surgery Specialization: Plastic and Reconstructive Surgery |
ME59792 | FL | Allopathic & Osteopathic Physicians |
| N | 2086S0127X |
Surgery Specialization: Trauma Surgery |
ME59792 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | FL MEDICARE | 18869V | 01 |
| FL | FL MEDICARE | 18869W | 01 |
| FL | 372847100 | 05 |
| Street Address |
1350 HICKORY ST STE 101 |
| City | MELBOURNE |
| State | FL |
| Zip Code | 32901-3224 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407822042 | Daniel N Segina | Orthopaedic Surgery | 1350 Hickory St Ste 101, Melbourne, FL 32901-3224 | 2006-02-24 |
| 1316287345 | Scott Zenoni | Surgery | 1350 Hickory St Ste 101, Melbourne, FL 32901 | 2013-02-28 |
| 1205112471 | Stacey Elizabeth Mercer | Physician Assistant | 1350 Hickory St Ste 101, Melbourne, FL 32901 | 2011-11-01 |
| 1396917522 | Kimberly Ann Vonderlieth | Physician Assistant | 1350 Hickory St Ste 101, Melbourne, FL 32901 | 2008-03-27 |
| 1245452606 | Steven A Khalil | Surgery | 1350 Hickory St Ste 101, Melbourne, FL 32901 | 2007-05-03 |
| 1619926169 | Gary James | Physician Assistant | 1350 Hickory St Ste 101, Melbourne, FL 32901-3224 | 2006-05-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467062943 | George Pappas | Anesthesiologist Assistant | 1775 W. Hibiscus Blvd., Ste 215, Melbourne, FL 32901 | 2020-08-09 |
| 1124676820 | Abbi Dell Lee | Behavioral Analyst | 3251 Engineering St, Melbourne, FL 32901 | 2019-08-27 |
| 1750856878 | Jeffrey Michael Cavanagh | Behavior Technician | 3251 Engineering Street, Melbourne, FL 32901 | 2018-10-04 |
| 1740766021 | Amanda Miller | Behavior Technician | 1885 W Hibiscus Blvd, Melbourne, FL 32901 | 2018-07-19 |
| 1396244406 | Dragen II LLC | Urology | 129 W Hibiscus Blvd Ste D, Melbourne, FL 32901 | 2018-02-03 |
| 1225550692 | Cabrit Psychotherapy Services LLC | Marriage & Family Therapist | 100 Rialto Place, Suite 700, Melbourne, FL 32901 | 2017-07-07 |
| 1487188058 | Project Response, Inc. | Clinic/Center | 747 S. Apollo Boulevard, Melbourne, FL 32901 | 2017-04-20 |
| 1184174575 | Paulette Swanson | Physical Therapist | 611 East Sheridan Rd, Melbourne, FL 32901 | 2016-10-10 |
| 1841747839 | Nicholas Wilson | Social Worker | 3661 S. Babcock St., Melbourne, FL 32901 | 2016-09-07 |
| 1467804278 | Nickolas Hetherington | Occupational Therapist | 1900 S Harbor City Blvd Ste 108, Melbourne, FL 32901 | 2016-07-05 |
| Find all providers in zip 32901 | ||||
| Taxonomy Code | 2086S0122X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Plastic and Reconstructive Surgery |
| A surgeon who specializes in plastic and reconstructive surgery. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A General Certificate is issued by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093834954 | Victoria Vitale-lewis | Surgery | 504 4th Ave, Melbourne, FL 32951-2545 | 2007-03-29 |
| 1497996946 | Rebecca Cissell Novo | Surgery | 6559 N Wickham Rd Ste C-105, Melbourne, FL 32940-2039 | 2009-03-12 |
| 1134367964 | George N Collis | Surgery | 1223 Gateway Dr, Suite 2b, Melbourne, FL 32901-2607 | 2009-02-02 |
| 1407978703 | Amy M Simon | Surgery | 707 W Eau Gallie Blvd, Melbourne, FL 32935-5958 | 2007-04-06 |
| 1164474276 | Health First Physicians, Inc | Surgery | 1223 Gateway Dr, Melbourne, FL 32901-2607 | 2006-05-17 |
| 1881658144 | Mauricio Jose Castellon | Surgery | 1499 S Harbor City Blvd, Ste 301, Melbourne, FL 32901 | 2006-04-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568025419 | Reinventme, LLC | Surgery | 13696 N Us Highway 441 Ste 100, Lady Lake, FL 32159-6815 | 2019-04-17 |
| 1750854378 | David Gerth Md Pa | Surgery | 4308 Alton Rd Ste 940, Miami Beach, FL 33140-4560 | 2019-01-07 |
| 1588165773 | Deepak Naidu Md, Pa | Surgery | 201 E Kennedy Blvd Ste 410, Tampa, FL 33602-3641 | 2018-02-23 |
| 1194225599 | Joseph Charles Gallagher Jr. | Surgery | 9201 Midnight Pass Rd, Sarasota, FL 34242-2921 | 2018-02-13 |
| 1043729569 | Renee Gasgarth, M.d. P.a. | Surgery | 7300 Sw 62nd Pl Ste 200, South Miami, FL 33143-4800 | 2017-09-27 |
| 1184150625 | Pamela Loftus | Surgery | 4454 Woodfield Blvd, Boca Raton, FL 33434-5310 | 2017-05-03 |
| 1356898324 | Waters Edge Dermatology Global LLC | Surgery | 2601 S Kanner Highway, Stuart, FL 34994 | 2016-09-07 |
| 1629482096 | Jill Swindell | Surgery | 1921 Waldemere St Ste 801, Sarasota, FL 34239-2913 | 2014-06-13 |
| 1205274784 | Melanie L Aya-ay Md Plastic Surgery Pl | Surgery | 17523 N Dale Mabry Hwy, Lutz, FL 33548-4521 | 2013-06-06 |
| 1790123487 | Jason Crespo | Surgery | 1250 Pine Ridge Rd Ste 101c, Naples, FL 34108-8913 | 2013-06-05 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.