Basic Information
| Provider Information | |||||||||
| NPI: | 1043299985 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YOHANNES | ||||||||
| FirstName: | PAULOS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1845 VETERANS PARK DR STE 110 | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341090493 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2396241160 | ||||||||
| FaxNumber: | 2396241161 | ||||||||
| Practice Location | |||||||||
| Address1: | 1845 VETERANS PARK DR STE 110 | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341090493 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2396241160 | ||||||||
| FaxNumber: | 2396241161 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2006 | ||||||||
| LastUpdateDate: | 11/07/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 21850 | NE | N | Allopathic & Osteopathic Physicians | Urology | 208800000X | ME137408 | FL | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 100552400 | 05 | FL | MEDICAID | JM084 | 01 | FL | MEDICARE | OTHER | V57EM | 01 | FL | BCBS | OTHER |