Provider Demographics
NPI:1366972341
Name:BLETSIS, PANAGIOTIS (MD)
Entity type:Individual
Prefix:
First Name:PANAGIOTIS
Middle Name:
Last Name:BLETSIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 N 12TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2837
Mailing Address - Country:US
Mailing Address - Phone:602-521-5969
Mailing Address - Fax:
Practice Address - Street 1:1441 N 12TH ST FL 2
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2837
Practice Address - Country:US
Practice Address - Phone:602-521-5969
Practice Address - Fax:602-521-5904
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR76389208600000X
OH35.144114208600000X
AZ69478208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery