MEDICARE: GEORGE E KOPIDAKIS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	ME74612	FL
2	208600000X	Surgery Physician	MA05921000	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P951167	OTHER	FL	OPTIMUM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	367678	OTHER	FL	AVMED
4	P01214443	OTHER	FL	RAILROAD MCR
5	P1011919	OTHER	FL	FREEDOM HEALTH
6	802555	OTHER	FL	WELLCARE
7	0900046	OTHER	FL	CIGNA
8	14R8X	OTHER	FL	BCBS OF FL
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679556757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE E KOPIDAKIS MD

Provider Business Mailing Address
First Line	:	1530 LEE BLVD
Second Line	:	SUITE 1100
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33936-4893
Country	:	US
Telephone Number	:	239-368-0241
Fax Number	:

Provider Business Practice Location Address
First Line	:	1530 LEE BLVD
Second Line	:	SUITE 1100
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33936-4893
Country	:	US
Telephone Number	:	239-368-0241
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	04/24/2018

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Directions to “ GEORGE E KOPIDAKIS MD” Practice Location

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