Provider Demographics
NPI:1235929712
Name:THEOHARIDES, THEOHARIS C (MD)
Entity type:Individual
Prefix:PROF
First Name:THEOHARIS
Middle Name:C
Last Name:THEOHARIDES
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6804 ARECA BLVD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34241-7104
Mailing Address - Country:US
Mailing Address - Phone:617-217-8408
Mailing Address - Fax:
Practice Address - Street 1:7595 SW 33RD ST
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-7708
Practice Address - Country:US
Practice Address - Phone:813-574-5218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1939207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Single Specialty